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Ms Pregnant

Ms Pregnant

Over the last few weeks, I’ve been having some fun with some pregnant ‘characters’.

Ms Average, Ms Standard, Ms Evidence-Based and Ms Cavewoman have all given birth in their own ways.

But what can we learn from their stories?  Let’s compare and contrast…

Birth choices

Our Ms Pregnant characters all had similar characteristics.  They were all ‘low-risk’, having their second baby, and receiving their care in the UK.

Ms Average was an example of the most popular birth choices.

Ms Standard had the default care offered on the NHS.

Ms Evidence-Based made choices based on academic research.

Ms Cavewoman did what came naturally with no other backup or information.

They were all fictional …and some of the details of their lives were more made up than others (read: sometimes I filled in the blanks or made creative connections to tell a story.  So these articles are in the ‘just for fun’ category.  Hold off on awarding me that Doctorate…).

Place of birth

Ms Average and Ms Standard gave birth in a hospital.  Ms Evidence-Based and Ms Cavewomen gave birth at home (or at cave).

Attendants

Everyone except Ms Cavewoman had a Midwife with them.  Ms Evidence-Based had a Doula, and Ms Cavewoman had a friend who acted like a Doula.  All the characters also had their husbands with them (although Ms Cavewoman’s was outside).

Pain Relief

Ms Average used ‘Gas and air’ and breathing exercises.

Ms Standard used ‘Gas and air’ and water when she fancied it.

Ms Evidence-Based used water.

Ms Cavewoman didn’t feel the need to relieve any pain.

Birth position

Ms Average gave birth on her back.

Ms Standard and Ms Evidence-Based found a position which was comfortable (but not lying down).

Ms Cavewoman squatted.

Placenta/’Third Stage’

Ms Standard had an injection in her thigh and the baby’s cord was clamped very quickly after birth.

Ms Evidence-Based and Ms Cavewoman gave birth to the placenta naturally.

Breastfeeding

Ms Average started to breastfeed but switched to formula by the time her baby was six weeks old.

Ms Standard was encouraged to breastfeed.

Ms Evidence-Based and Ms Cavewoman breastfed.

General conclusions (or rash assumptions)

My overall interpretation from all of these characters is that many women in the UK are not having an evidence-based birth.

And the birth which is evidence-based is nearer the experience of Ms Cavewoman’s than Ms Standard (Ms Standard represents care which follows the NICE Guidelines).

It’s also interesting that whilst Ms Average gives birth in hospital, she’s not necessarily getting the care recommended to Ms Standard.

For example, if Ms Standard is encouraged to give birth in a position which is not lying down (and this is also what happens for Ms Evidence-Based and Ms Cavewoman), why are most women in the UK giving birth on their backs and in bed?

And if the evidence shows that cutting and clamping the baby’s cord immediately after birth is not as beneficial as waiting until later, why do the NICE guidelines still recommend that it is done straight away?

And why do most low-risk second time mothers not give birth at home, even though the latest study shows that it has the best outcomes for mother and baby?

Answers on a postcard.  Or better, a comment on the blog!

References and further geekery:

Ms Average

Ms Standard

Ms Evidence-Based

Ms Cavewoman

Birthplace Study

Standard disclaimery type thing: none of this is medical advice.  Please consult your own medical team/intuition when making decisions on your pregnancy care.  Information is as best as I understand it but I could have got entirely the wrong end of the stick.  You know all the rest…

What one thing has surprised you most from the Ms Pregnant series?  Please list it in the comments below, and explain what changes (if any) you’d like to see to the care offered instead.

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Ms Cavewoman

Ms Cavewoman

I’m forever reading about mythical cavewomen.

It’s an analogy often use in birth-related stuff.  ‘What would a cavewoman do?’  ‘Use your animal brain,’  ‘Find your inner monkey,’ and so on.

Extensive research* has not yet made me find any evidence about how cavewomen actually gave birth.  There aren’t any YouTube videos up, for example, and I don’t recall it being covered in The Flintstones.  Although I did find a video of a chimpanzee giving birth in a zoo, which is practically the same.**

Ms Cavewoman’s birth story

However, there’s nothing wrong with me having a go, is there?  The point of the story is the same, even if it may not be anthropologically accurate.  Ms Cavewoman could be Ms Au Naturel.  Unlike modern times, she doesn’t have the back up of any medical technology.  But what might happen if she …just gave birth?  Let’s imagine her story:

Ms Cavewoman has no idea how old she is, because measuring time isn’t that accurate.  She’s several seasons old, however.

She’s expecting her second cavebaby.

Ms Cavewoman has grown up seeing other women give birth and feed babies.

She’s not read any pregnancy books, as books haven’t been invented yet.  And she’s managed to avoid One Born Every Minute, even though it’s on every cave wall in the country.

She hears stories round the fire from her cavewomen friends about how their own children were born.  She’s watched other women give birth, too, in her time.

When she goes into labour, Ms Cavewoman wants to make sure she’s not going to be bothered by any sabre-toothed tigers.  They are considered a great inconvenience when giving birth.  She goes into her nice warm, dark cave, and puts Mr Caveman at the door to defend it.

Her friend pops over to be with her and they talk softly and plait each other’s hair as she has some contractions.

As Ms Cavewoman is not at all frightened of labour, she gets into whatever position seems most comfortable and makes noises to suit her mood.

When she can feel that the baby wants to be born, she shifts into a squatting position and gives birth to the baby very easily.

She kisses, rubs and licks her baby to help him begin to breathe.

Once ‘Desmond’ is born (I have no idea why he’s called that; he just is), she lies back on a pile of animal skins and wraps up as he begins to feed.

The placenta comes a little while after and it remains attached until it falls off a few days later.

After a bit of a sleep, Ms Cavewoman wraps Desmond up in one of the skins and ties him round her to keep him close.  Then she and the other cavepeople have a feast to celebrate the baby’s arrival.  Her friend clears up the cave and all is well.

…Well, it might have happened.

*Five minutes on the internet.

**It’s not.

References and further geekery:

Gaskin, I.M.  (2002).  Spiritual Midwifery.  Summertown: Book Publishing Company.

Gaskin, I.M.  (2003).  Ina May’s Guide to Childbirth.  New York: Bantam Dell.

Anything by Sheila Kitzinger: birth expert and anthropologist.

Wiessinger, D. West, D. and Pitman, T.  (2010).  The Womanly Art of Breastfeeding.  New York: The Random House.

According to this infographic, the story above is a ‘paleofantasy‘ – cool!

Chimpanzee giving birth in a zoo (YouTube).

How does Ms Cavewoman’s birth strike you?  Are there any elements of her birth that you’d like for yourself?  Please let me know in the comments below.

Ms Evidence Based

Ms Evidence-Based outlined with a magnifying glass

Ms Evidence-Based is a stickler for facts.

She’s not going to make her birth choices based on what she’s read in the latest celebrity magazine.  Oh no!  She wants it backed up by cold, hard science.

Now, before we go any further, we’re all agreed that Ms Evidence-Based is fictional, and that there’s a lot of evidence about and that she might not have read all of it (a bit like the blogpost author), yes?  And that nobody will be basing any life or medical decisions on some random post off the internet?  Good?  Lovely.  Let’s continue…

Ms Evidence-Based’s story

Ms Evidence-Based is 26, as that’s the age most people would recommend as the ‘best’ for giving birth.

It’s her second baby, and she doesn’t have any other medical conditions or ‘risk’ factors.

Ms Evidence-Based decides to give birth at home.  This is because as it’s her second child, the Birthplace study says she can expect the best outcome for her and the baby’s health by avoiding hospital.

She has a Midwife with her, as having a skilled attendant helps to mitigate against maternal and infant death.

Ms Evidence-Based has antenatal health check-ups.

She uses a birth pool for some of her labour, as immersion in warm water will reduce the likelihood of her requesting to transfer to hospital to have an epidural (she wants to avoid an epidural as having this intervention will increase her chances of an instrumental delivery).

As well as her husband and Midwife, Ms Evidence-Based has hired a Doula, as continuous, emotional support from a non-family member improves her likelihood of having a birth without interventions.

It will also make her labour shorter!

Ms Evidence-Based requests that once the baby is born, the baby’s cord is not clamped so that as much blood as possible can pass between the placenta and the baby.

Once baby ‘Samantha’ has arrived, Ms Evidence-Based breastfeeds her.  She’s in frequent contact with breastfeeding support groups as she knows that regular support (especially face-to-face) will increase her chances of being able to feed for longer.

She continues to have her Doula visit for a few weeks post-natally, as feeling supported may reduce her risk of developing Post Natal Depression.

And the Doula can bring chocolate.  Which is just good.

References and further geekery (not all academic):

Age to give birth (based on popularity of recommendation, rather than health outcomes)

Home birth for ‘low-risk’ second-time mother and baby – Birthplace in England study and BMJ summary of its findings

Epidurals increase likelihood of instrumental delivery – Cochrane summary

Skilled attendant and healthcare effect on birth outcomes – Cochrane summary

Waterbirth reduces need for epidural – Cochrane summary

Continuous emotional support in labour (and beyond) – Evidence Based Birth’s summary; Doula UK reference page; Klaus, M. Kennell, J. and Klaus, P.  (2012).  The Doula Book.  Boston: De Capo Press.

Delayed cord clamping

Breastfeeding – WHO recommendations

Breastfeeding – regular support increases likelihood of a mother and baby continuing to breastfeed

Chocolate and Oxytocin – Netdoctor

For doing your own research:

Evidence Based Birth – website which summaries findings on a number of birth-related topics

Cochrane Collaboration – reviews of medical research across different genres, including pregnancy and maternity

Google Scholar

This article was published on the 31st May, 2013.

Magnifying glass: denverjeffrey.

Did you find looking at medical evidence useful in pregnancy?  Or is it a distraction?  Please let me know in the comments below.

Meet Ms Standard

Ms Standard logo with checkbox

Last week, I wrote about Ms Average – a woman who takes the most popular choices for giving birth.

But what if you don’t want to make any choices?  What happens if you take the standard, default offering with no customisation to suit your own needs and preferences?

Ms Standard has chosen this route.  She could easily have been called Ms Default or Ms Nice.  Here’s why…

It’s all about the guidelines

In the UK, all maternity providers are meant to observe the NICE (National Institute for Health and Care Evidence) guidelines.

There are different standards for different scenarios – antenatal checks, caesarean birth, low-risk labour and so on.

In addition, hospitals and NHS Trusts may have their own policies or protocols for labour.  And Midwives have to abide by their own professional codes.  So there are a lot of regulations and rules flying around.

The default option

In some ways, it makes sense.  In the absence of anyone (cough cough, you) suggesting otherwise, there’s a baseline set of standards to start from.  This means that if you have a change of shift halfway through labour, or move house during your pregnancy, you should receive a similar type of care.

Of course, there are times when women don’t receive care which meets the guidelines, but that’s probably another blogpost…

Even if you don’t live in the UK, your care providers will probably have a standard template that they will follow as a default option for birth.  It’s worth finding out what their particular ‘map’ is.

Ms Standard’s birth

To make things easier, I’m going to assume that Ms Standard is giving birth in a hospital which follows the NICE guidelines to the letter and doesn’t have its own policies on top.  I’ve also assumed that she’s not going to choose an Epidural, or have any complications during her birth.

Ms Standard is a ‘low-risk’ mother having her second baby.

She goes into labour naturally.  Her waters haven’t broken when she arrives at the hospital.  She’s brought her husband, Mr Nice, along.

She’s met with a smile by the Healthcare Professional (HCP) looking after her.

The HCP (usually a Midwife) checks her temperature, blood pressure, pulse; asks for a wee sample and feels her belly.

The Midwife also asks her about any vaginal discharges or whether her waters have broken.

She then listens to the baby’s heart for one minute.

A vaginal examination is offered.

They discuss options for pain relief.

The option for labouring in water should be available.

‘Gas and air’ should be available for pain relief.

Pain-relief drugs given by injection (e.g. Pethidine) should be available, but Ms Standard won’t be able to use a birth pool for two hours if she has one of these injections.

Ms Standard’s labour isn’t considered ‘established’ until she is having ‘painful’ contractions and her cervix is 4cm dilated.  If she comes to the hospital early, she may well be asked to go home.

Once ‘established’, she is expected to make it to 6cm within two hours and continue to dilate another 2cm every two hours.

Once her labour has got going, she has at least one professional ‘supportive’ person with her at all times (this is usually a Midwife, but the NICE guidelines don’t name the profession of the ‘supportive’ person.  I’m going to assume it’s a Midwife for this piece).

Ms Standard will be in a labour room on the labour ward.

The Midwife will start her medical labour written records.

Ms Standard will have her blood pressure checked every 4 hours.  She’ll also be offered vaginal examinations at the same interval.

Her pulse will be taken hourly.

The baby’s heartbeat will be checked every 15 minutes, for one minute.

Ms Standard will be asked about her pain relief requirements every so often.

Once Ms Standard starts to feel the urge to push, she’ll be expected to birth her baby within two hours.  However, if the baby hasn’t been born within an hour, then Ms Standard will be referred to an Obstetrician for possible instrumental assistance.

As the birth is nearer, vaginal examinations will now be offered every hour.  Her blood pressure and pulse will also be checked at the same frequency.

The baby’s heartbeat will be checked for one minute, every five minutes.

Ms Standard will be encouraged to find a position to give birth that isn’t lying down.

Once the baby is born, Ms Standard will have an injection to make the placenta come more quickly.

The cord will be clamped very quickly and the Midwife may pull on it slightly to help it release.

It will be expected within 30 minutes.

The baby will have a breathing and condition check when s/he is one minute and five minutes old.  This is known as an ‘Apgar’ test.

The Baby will be dried off and placed on Ms Standard’s chest, with a towel over them both to keep them warm.

Baby Standard (‘Boris’) will stay on Ms Standard’s chest for an hour, after which he will be weighed and measured.

The Midwives will support Ms Standard to start breastfeeding Boris within the first hour of his life.

After Boris is weighed and measured, he’ll then have a further check which will look for physical abnormalities.

The Midwife will continue to check Ms Standard’s pulse and blood pressure, and make sure that she can have a wee.

She will check to see if there was any tearing, and make arrangements for stitching as necessary.  Ms Standard may need to lie down with her legs in the air for the checking or stitching to take place.

If any tearing is found, a rectal examination may be offered.  Medication may also be offered rectally to reduce swelling.

As it’s her second baby, Ms Standard will either go home after six hours or one night, depending on the hospital’s discharge policy.

References and further geekery:

NICE Guidelines for labour (aimed at Healthcare Professionals)

NICE Guidelines for labour (aimed at parents)

Northampton General Hospital labour guidelines (example of a NHS hospital protocol)

I’m aware that NICE is reviewing the guideline for the default option for managing the placenta after the baby is born.  The information above is my understanding of what is in force at the time of publication (24th May 2013).  I’m not a Midwife or Healthcare Professional.  If you are and I’ve misunderstood something, please correct me below!

Is Ms Standard’s birth the one you’d want?  Would you change anything on the list above?  Please tell me more by leaving a comment below.

Are you Ms Average?

Mathematical symbols for 'average' with the word 'Ms' highlighed to create the meaning, 'Ms Average'.

Of course not!  You are Ms (or Mr) Extraordinarily Fabulous.

I know this, because you are reading my blog.

However, I’ve been having a dig around at some statistics to see if I can create a profile for the ‘average’ woman giving birth in the UK.

Proper statisticians will probably faint at my analysis, but here goes anyway…

(Watch this space for more in the ‘Ms Pregnant’ series later… as well as some thoughts on what to consider if you definitely don’t want to be ‘average’!)

Meet Ms Average.

She’s 30, having her second child, and earns £26,500.

Her baby will be born at 39 weeks and 6 days.

Labour will last seven and a half hours.

Ms Average’s first name is Elizabeth.

When she found out she was pregnant, she went to see her Doctor but all her care after that was with NHS Midwives.

Elizabeth had the standard scans and blood tests offered by the NHS to check the baby’s growth and screen for abnormalities.

She’s decided to give birth in hospital.

She won’t have met the Midwife who’s with her in labour before she has the baby.

Her labour will start naturally (although one of her four other pregnant friends will have been induced).

Elizabeth will use gas and air at some point in her labour for pain relief.  She’ll also try breathing exercises.

She has around a one in three likelihood of having an epidural or using Pethidine (pain-relief injection).

She has a one in four chance of having a caesarean section.

Her partner will be with her during labour.

She’ll give birth vaginally, lying down in bed.

Her baby will weigh 7 1/2 lbs.

She’ll call him Harry.

Elizabeth wants to breastfeed Harry, and she’ll start off doing so.

However, by the time of her six-week check up, she’ll have switched to artificial milk (formula).

Overall, she’ll be quite pleased with her pregnancy and birth experience.

Her favourite chocolate bar is Cadbury’s Dairy Milk.

Were you surprised by anything on this list?  What do you think of this depiction of an ‘average’ UK birth?  Please let me know by leaving a comment in the box at the bottom of this post!

References and further geekery:

BirthChoiceUK

UK average earnings 2012 – BBC News report

Length of gestation – SpaceFem’s own research project

Length of labour for a second baby – pregnancy.com.au

Most popular name for girls in UK (1983):  It was definitely Elizabeth.  I’ve read it in couple of books which I don’t have to hand.  You’ll just have to believe me.  (NB: Never trust anyone you’ve met off the internet…)

Midwife 4 Me / The Birth I Want video – knowing your Midwife before birth  (This is a powerful video.)

Baby weight at birth – midwivesonline.com

UK Baby names 2011 – Office for National Statistics

UK Breastfeeding initiation rates – UK Department of Health

Women’s experiences of NHS maternity care – Care Quality Commission

UK’s most popular chocolate bar – MoneySavingExpert and Daily Telegraph reports.

Note: Not all of the links above are to beautifully referenced academic information.  I have rounded/averaged some of the numbers a little to make the article easier to read.  Ms Average’s birth is based on my understanding of what the majority of women did according to the research studies and online articles I read.  It is unlikely to stand up to academic scrutiny.  This is just a bit of fun…

Anyone who disagrees with the chocolate survey results is requested to forward rival samples to me for further in-depth analysis.

The four and a half words that may be a warning sign for your birth…

Warning road sign

Four and a half words.  Four and a half little, tiny words that can make a big difference to how you feel about your birth.

Not, “Congratulations, Madam – you’re pregnant!”

Nor, “D’ya want fries with that?”

But these:

“They Won’t Let Me.”

“They won’t let me!”  Something you’ve probably said at least once in the last nine months.

It’s a phrase which puts a little chill in my heart, and starts enormous alarm bells ringing in my head.  And I think if you’re saying it a lot, you’re not going to have a happy time.

So let’s unpack it a little:

‘They’

Who or what is the ‘they’ in your mind when you say this phrase?  A secret, hidden pregnancy mafia out to get you if you do something ‘wrong’?  Your Doctor?  Every Doctor?  All hospitals in the country?  The NHS?

‘They’ makes it sound like ‘them and us’.  Like a war where you are fighting a load of enemy combatants (whilst desperately seeking people who are on your side).

It’s a nameless group of people, and like the weird shadowy figures in nightmares – those figures are to be feared.

So name the person or thing causing your trouble.  It will bring you more clarity about where the problem lies.  The clarity should reduce your fear – and point you in the direction of people who can help.

‘Won’t Let’

‘Won’t let’ sounds like you need permission.  It also tells me that maybe you don’t have enough information about what your healthcare provider is recommending.

In the worse case, it suggests a healthcare provider who is patronising you and acting as though you are a child.

What do you really mean by ‘won’t let’?  That something is not recommended?  That something’s illegal?  That something is being held back from you with no justification?  Name it.  Work out what’s behind the statement.  Are you afraid of digging deeper?  Take notice of that feeling: it’s telling you something important.

‘Me’

You!  Wonderful, lovely you.  The phrase is all about how you are feeling.  Frightened?  Frustrated?  Disempowered?  What’s really going on when you say someone ‘won’t let you’ do something?  How do you feel?

How would you like to feel?

The whole thing

OK, this is a bit of tough love – but the whole phrase?

It makes you sound like a child.

Not in an ‘oh she’s four and look how cute‘ way.

But in the way which conforms to Eric Berne‘s theories of how we communicate.

Berne thinks that there are three types of communication personality which humans (of all ages) have.

He names them ‘parent’, ‘child’ and ‘adult’.

In all the forms of communication apart from ‘adult to adult’, the power balance is off in the conversation.

In an ‘adult to adult’ conversation, you are equal with the person you are talking with.

In a ‘child to parent’ conversation, you are giving the other person your power and assuming that somehow their role is to ‘look after’ or ‘be in charge’ of you.

‘They won’t let me’ is not a phrase said by a person who is in control and content with the situation.

It’s said by someone who’s frustrated by their lack of autonomy.

Alternatives

So how can we ‘hook the adult’ and get ourselves back to a place where we feel excited and happy about the pregnancy decisions we’re making?  Here are some suggestions:

Red bell hanging from a door

Ding ding ding ding ding!

1) Sound the alarm bell.

Every time you hear yourself thinking or saying the phrase, “They won’t let me…” – STOP!  Put a picture of a big alarm bell in your mind and congratulate yourself for noticing.

2) Replace words and work out what’s really behind the message.

You’re looking for Who, What, and How I feel/What I’d like…

For example:

“They won’t let me… book a home birth.”

…becomes

They

Identify exactly who you mean.  [Who]

The Doctor…

wouldn’t let me

What was the specific situation or cause? [What]

was following the local guidelines about advice for home birth and suggested that I had my baby in hospital

How did you feel or react to it?  [How I feel]

I didn’t know why he was suggesting this in my circumstances and I feel a bit confused.

What would you like to happen or change?  [What I’d like]

I’d like to talk to a home birth expert to see if I have any other options.

Here’s another scenario:

“They won’t let me… have my mother and my husband in the birthing room.”

…becomes

The Midwife leading the tour round the hospital [Who]

said that their rules are that only one person was allowed into the birthing room to support me. [What]

I am horrified at the idea and feel frightened and torn about who to choose.  [How I feel]

I would like to have both my Mum and my husband with me when I give birth.  [What I’d like]

3) Take action to make it happen!

If swapping the words round meant you identified what you really want to happen with your birth choices, the next step is to …make it happen!  Can you contact a Supervisor of Midwives to change or explain a policy?  Hire a Doula to be your advocate?  Find a local support group for women with a similar medical or birth history?  Come to terms with whatever the situation is, and accept it?

Being in charge of your own birth-related decision-making will feel so much better than someone else making choices you don’t want on your behalf.  Get that warning bell at the ready and ask for clarification until you are comfortable.

I would write more on this, but, y’know… it’s late, and they won’t let me.

When was the last time you thought ‘they won’t let me’?  Did changing the words using the suggestions above help?  Please let me know what you discovered by leaving a comment below.

PS I hope this is obvious, but I’m not suggesting that you ignore the advice of your healthcare providers… just that you are clear in your understanding of the reasons behind what they are suggesting.  Frustration-free birthing FTW!

Thanks to openDemocracy and seanmcmenemy for the pictures.

Life and Death Radio

Black radio, taken in black and white. Image by S Diddy

I shed a little tear at work today.

Not just because I was looking at a rather dull spreadsheet when it was sunny outside.  But because whilst I was wrestling with said spreadsheet, I was also listening to a story of the line between birth, life and death.

Step forward, RadioLab

I’ve mentioned before that as well as being a birth geek, I also have another love – radio.

RadioLab is a podcast which is also broadcast on NPR – America’s equivalent of BBC Radio.

RadioLab’s way of making audio is unlike anything you’ve heard before.  The best way I can describe it is like the audio version of a TED infographic.  They weave different voices and reactions together to tell a story that’s like an audio cartoon.  It doesn’t always work (sometimes I find myself getting confused about who is who if there are many speakers involved in the telling).  However, they are not afraid to interrogate a topic and the inclusion of the asides from a contributor that would normally get left out leave audio offerings that are addictive to the ears.

Powerful radio

The episode I’m about to wax lyrical to you about?

April 30th, 2013‘s.  The story of a couple who had a baby born at 23 weeks, and 6 days.

Life, death …and the space in between

I’ve often thought that you can tell a lot about how someone thinks about birth, by how they feel about death.

The two events are flip sides of the same coin.  An ending, a beginning.  Something people are frightened of, or trust completely.  An inevitable next step in the onwards march of evolution, or a continuation of the Circle of Life (complete with Simba and a Lion’s head in the clouds).

You know, all of that ‘deep’ stuff.

Whatever your take on all the ‘deep’ stuff, the life/death line is pretty compelling.

Hear people talking about it with raw honesty and it’s like a magnet attached to your ears.  Your brain is going to crackle as you focus in on hearing stories that sit right at the heart of the meaning of why we’re here.

Or maybe that’s just me after too many spreadsheets…

The story

Kelley and Tom had tried for a baby and ended up having IVF with the assistance of an egg donor.

Unfortunately, the baby started trying to be born early.

Much too early.

After being in hospital for a while, eventually Kelley ended up having her daughter at 23 weeks, and 6 days.

Viability

This raised all sorts of questions.  In America, 24 weeks is seen as a ‘cut off’ for a baby having a chance of making it.  The podcast looks into the history of this decision and examines how technology has changed since the issues were first examined in the 1970s.

Kelley and Tom had to decide whether to allow their baby to die gently in their arms, or if they should try to use medicine to intervene to save her.

They describe the agonising night when they were deciding whether to say ‘yes’ or ‘no’ to authorising an attempt to revive her.

It’s like a world of philosophical debate is being channelled through one set of parents in the space of a few sleepless hours.

Will v Science

The next section examines the significance of a baby’s grip on a finger.  Is it the child’s determination to live shining through?  Or just a reflex, biological action?

We hear from a NICU (Neonatal Intensive Care Unit) Director with his own perspective – there’s a twist in his tale.

“Was the Doctor in you surprised at the Father in you?”

…ask the presenters.

You’ll have to listen to find out why it wasn’t the other way around.

The story of one baby’s life is the story of all of our lives

NICU Nurses tell of their experiences of watching babies who get sick, and caring for the ones that don’t make it.

Kelley talks about the disorientation of being in the cheerful surroundings of a Maternity unit one day, and the despair of NICU a few days later.  The floors between the two areas of the hospital are a symbol for two different worlds.

Tom decides to start reading his daughter Harry Potter as a way to keep connected.  She appears to like it – but is that biology again?

“I don’t know a better way to describe being alive… you want to know what happens next,”

says Tom, as he explains why he found reading to his daughter so helpful.

The Nurses come back again to explain that Western society is just not very good at coping with the death of babies, any more.  The rest of the world is still used to it, they say.  It doesn’t make it fair.  Our Grandparents were also born in a time where not all the children would survive.  But technology has moved on for those in rich countries – and we aren’t sure how to manage when it fails us.

And in the end…?

From a radio point of view, the credits are done in an interesting way.  But that’s not what you want to know, is it?

All I’ll say is that if you have not cried during the rest of the programme, you will during the last ten minutes.  It’s powerful stuff.

But then, isn’t life itself?

You can hear RadioLab’s ‘23 Weeks 6 Days‘ on the RadioLab website, where it is also available to download.

It’s a rewarding, if challenging listen.  Congratulations to the programme team for making it and thank you to Kelley, Tom and the other contributors for sharing their story with such raw honesty.

Warning: The programme is a truly awesome (in the correct sense) listen, but it contains strong themes.  It covers IVF, abortion, miscarriage, neonatal death, prematurity, babies in Special Care/NICU, babies needing operations and related issues.  You may wish to consider this before choosing to listen.  If any of these are triggers for you, please see the ‘Help!‘ page.

If you liked the programme, please share this post with others so they can hear it, too. 

Disclosure: I have no connections with RadioLab other than hearing them speak at an industry conference once, and liking the podcasts that they produce.

Image: S. Diddy.

What kind of birther are you?

Different colour and sized question marks

Hairy Hippy?  Earth Mother?  Trouble-maker?  Worried patient? 

There are so many different types of woman, and ways to give birth.  Here’s a fun quiz to find out what kind of birther you are…

Question 1

You are planning to give birth…

a) In a Yurt in the middle of your eco-village

b) In the local hospital

c) In a birth pool at the nearby Birth Centre

d) In the supermarket, because you’ve heard they’ll give a free hamper to anyone who has a baby in aisle 18

Question 2

Your ideal birth companion is…

a) Mother nature

b) Your Mother

c) Your partner

d) Anyone who brings champagne

Question 3

You are in labour in hospital, and the Midwife asks if she can hook you up to a monitor.  Do you…

a) Agree immediately – after all, the medical staff know what they are doing!

b) Politely decline as this is not part of your Birth Plan

c) Ask why the Midwife thinks continuous monitoring would be appropriate, and what the benefits and risks would be

d) Immediately panic that there is something wrong with your baby

Question 4

The monitor is making an annoying bleeping sound, and has lots of flashing lights.  Do you…

a) Grab a home made shawl from your bag and throw it over the equipment to cover it up

b) Get a pair of ear plugs

c) Ask your partner to turn the volume on the machine down

d) Worry that all the noises mean that something’s wrong but feel too scared to ask for more information

Question 5

You feel like you want to push.  Do you…

a) Update Twitter and Facebook to let all your followers know

b) Start pushing

c) Call the Midwife to ask if you are ‘allowed’ to start pushing

d) Resist the urge to push as you are still on the bus and haven’t made it to the supermarket, yet

Question 6

After the birth, the placenta…

a) Should be kept out of my sight

b) Is something that the Midwife will deal with and dispose of safely

c) Is buried under a tree in honour of our newborn child

d) Makes a lovely pâté to be served at the baby-naming ceremony

Question 7

A brilliant name for the baby is…

a) Any character name from Eastenders

b) One picked at random from a baby book

c) Orville

d) Whatever the Doctor chooses – after all, they are the experts

Question 8

You’re planning a homebirth and discover you are expecting twins.  Do you…

a) Immediately switch to hospital-based care and follow every piece of advice the Consultant gives to the letter

b) Plan an elective caesarean

c) Ask a Supervisor of Midwives to support you and the local Midwives to continue with your homebirth plans

d) Ask your friends to start bulk collecting ‘buy one, get one free’ baby clothing vouchers

Question 9

Your friend recommends a post-natal Doula, as she found having one really useful to help out when she had her second baby.  Do you…

a) Wonder what a Doula is, but not feel brave enough to ask

b) Think she has accidentally turned into a hippy overnight

c) Agree with her wholeheartedly and book a Doula immediately – you want to make sure you do exactly what your friend does

d) Look up Doulas on the web and do your own research

Question 10

Nappies are…

a) Disposable – really convenient

b) Cloth – better for the environment

c) Unnecessary – we just follow our baby’s cues and hold them over the sink

d) Sold in aisle 18 of the supermarket

Mostly As, Bs, Cs or Ds, or a mixture?

You’re a human.

We’re all different.  We all have different hopes, wishes, fears and ways of dealing with the world.  There’s no ‘right’ way to birth.

If you choose to have a Doula to be part of your birth story, then you’ll find she is supportive and non-judgemental.  She won’t mind about what choices you make, so long as she knows you are happy and confident in those decisions.

You are far too extraordinary to be defined by a little box.

Having said that, I’m the kind of person that likes to question and probe.

So here’s the challenge: Do the quiz again, but select different answers.  What might it feel like to be that person, and make those birth choices?  What might the consequences be?  How does that feel?

What did you discover?  Please let me know by leaving a comment below.  I’d love to hear what you found out.

From flat whites to feeding…

Flat white coffee with heart shape made of milk on top

I knew I had officially turned into a London media wanker when I heard myself uttering the following in a coffee shop:

“I’d like a decaff soy flat white, please.  Extra hot.”

Whilst I’m sure the Barista had …opinions on this coffee choice, she put on her professional smile, looked at the cup to ask my name (I resisted the temptation to give her something comedy – I’d embarrassed myself enough) and moved on to the next order.

Y’see, her job was to give me what I’d asked for.  Without judgement.

And my job was to take responsibility for my choice.  And then put cinnamon on top of it (they always leave you to do that last bit, don’t they?)

Ask for what you want

I was reminded of this story when I was reading another account of ‘awful’ breastfeeding support.

My general birth geekery means I sit between a number of worlds – websites and email lists with experienced feeding support workers and books and blogs with Mums working it all out.

Both groups get upset and frustrated.  I think there’s a bit of a communication misfire going on.

A common story in the newer Mum world is, “I had some problems with breastfeeding and I wanted some breastfeeding support so I went to get some breastfeeding support and they only told me about breastfeeding.  What awful people, I ended up using formula and no one told me about it and I’m very sad.”

(I’m not trying to be make light of this kind of trauma – a rocky feeding relationship is really difficult for everyone, which is why the topic ignites such passion.)

The feeding supporters are more like, “I had a Mum come to see me and she’d been sent all round the houses by different people telling her nonsense and I listened to her story and my heart broke at what she’d been through.  She asked for some help with breastfeeding so we had a chat through her options and I suggested a few different positions she could try.  I hope things are working out for her.”

Breastfeeding baristas

Simply put, the Mum had asked the barista for a latte.  She’d got a latte.  The barista thought that what she wanted was a latte, so she made the best latte that she could.

But what was actually happening was that the Mum had heard that lattes were quite good but wasn’t sure if a macchiato would have been better.  Or maybe an espresso.  Grande or tall?  In a paper cup or a mug?

Ordering coffee is bloody confusing and everyone seems to have an opinion of the best way of doing it.

And aren’t these baristas meant to be coffee experts?!  Why didn’t they tell me about caramel shots?!…

If you can order a coffee, you can ask for help

If you know what you want, take a deep breath, look the barista in the eye and order the decaff soy flat white, extra hot.  They’ll give it to you.  It’s their job.

If you’re not so sure, ask your barista to explain the options.  They’d be delighted to help and show off their extensive knowledge.

You wouldn’t expect someone in a coffee shop to hand you an orange juice if you’d just ordered a Viennese with an extra shot.

And a breastfeeding counsellor wouldn’t expect to start giving you information on bottle feeding if you’d just asked her for advice on getting a better latch.

Moral of the story: if you’d like a cappuccino, don’t order a latte.  And if you’d like to chat through the pros and cons of formula feeding with a (breast)feeding counsellor, you need to tell them because they are not psychic!

And then, for heaven’s sake, sit down with them afterwards and have a nice cup of tea.  Coffee’s just too damn complicated.

Have you had a session with a breastfeeding counsellor?  Are you a breastfeeding counsellor?  What is your top piece of advice for being as clear as possible with what you’d like to find out?  Please leave a comment with your example so we can share the knowledge and reduce frustration!

I write (breast)feeding counsellor because despite their name, feeding support workers and volunteers will have knowledge of breast and bottle feeding.  The role titles can be a bit confusing but there’s a guide to the different kinds of feeding supporter here.

Picture credit: Damian Cugley

5 Ways That Water Can Make Birth Brilliant

Black and white photo of a hand held open under a running tap over a silver sink

Wat-er Wonderful World – here are five ways you can use water to support pregnancy and birth.

1.    Go swimming in it

Exercise can make you feel better, keep you fit and the buoyancy of water can help if you are feeling more like a whale than normal (I’m sure you look gorgeous).

Plus there might be an exercise class like Aquanatal where you can meet other pregnant Mums.

Having a support network and feeling part of a community are also good for our overall wellbeing, so double-win.

2.    Relax in it

I’ll admit a bias here.  I’m doing some training to be a Watsu® practitioner.  ‘Watsu®’ is ‘Water-Shiatsu’ but it basically means ‘lie in a nice warm pool while someone holds you in their arms and gently floats you about for an hour until you are so relaxed you don’t even know what your name is’.

Stress-busting and excellent for pregnant Mums – sounds like something to start dropping hints about as a potential present… (contact me if you’d like more info.)

3.    Use it for pain relief

There is great evidence that relaxing in warm water during labour reduces perceptions of pain.  You can use a special birthing pool to labour in or if space is tight, hop in the shower.  Some women also choose to give birth in the pool (it’s OK, the baby won’t start breathing until she/he hits the air, so won’t drown).

You can hire birth pools for use at home and many hospitals and birth centres now have pools on site.

For more information on waterbirth, check out Waterbith International’s information pages.

Some women also find that visualising a picture of crashing waves can help during contractions.  Even in the mind, water can still work wonders!

4.    Get your flannel out

A cheap and easy tip for labour?  Buy some low-cost flannels before the day.  Prime your birth companion to dip them in some cold water to put on your forehead or the back of your neck if you suddenly start feeling really hot.  Nice and refreshing (and it will make your partner feel useful).

5.    Drink it!

Obvious, but easy to forget.  Even though some American hospitals still ban women from eating and drinking in labour, the evidence suggests that you need to drink normally.  You wouldn’t run a marathon without a sip of water and giving birth is hard work.

If you are giving birth in a hospital, these can be very hot and stuffy places to be – this alone is dehydrating.  Try taking some bottles of water with you, which you can refill (your birth partner will probably need their own supplies as well).

An advantage of drinking water in labour?  It means you need to wee!  This is great, as not only does it make sure you move every so often to head to the bathroom, it also stops your bladder from becoming full.  Every little bit of space helps to get the baby out.

References and further geekery:

Wellbeing: MIND – Physical_activity

Action For Happines – 10 steps

Waterbirth evidence: Evidence Based Birth’s Waterbirth research sheet

Visualising waves: Byrom, S.  (2011).  Catching Babies: A Midwife’s Tale.  Ebook: Headline Publishing Group.

Morgan, M.  (2005).  Hypnobirthing.  London: Souvenir Press.

Eating and drinking in labour: Cochrane review

NCT roundup

Empty bladder: Gaskin, I. (2002).  Spiritual Midwifery.  Summertown: Book Publishing Company.

Thanks to gagilas for the photo of the tap.

Did you try any of the above suggestions in labour?  Which one worked best?  Please share your experience in the comments below!