Tuesday, 18 August 2015

C Section Rates - The Economist Edition

So I was going to take a break from blogging this month. It's the school holidays and I've been trying to juggle childcare, work and my new sideline reviewing festivals (check out the fab Festival Kidz website btw). Frankly, I'm exhausted.

But, MrSB sent me an article in the Economist and now I'm sneaking back in here for a bit of a rant. Actually, it didn't make me all that cross, it was more a despairing sigh than anything. I'll fess up to not being a regular reader of The Economist. Frankly, if I had any interest in economics I wouldn't be working part time in a lab. So I had always assumed it was a pretty serious publication and would likely deal with numbers and data in an intelligent and non sensationalist way.

oops, my bad!

Essentially it is (yet another) story about how there are far too many C sections going on and it could have been cut and pasted from any of the many similar pieces. In fact, let's play a little game shall we?

HOUSE!!  This article has the lot.

There is nothing new or insightful here in fact I'm a bit puzzled as to how it is news at all as it seems to be based on a Lancet article and subsequent WHO statement that I (among others) wrote about back in April.

The only novel thing is an interactive infographic which plots C section rate against maternal mortality. From which the writer concludes that where the Cesarean rate is above 10-15% (so basically the entire developed world) the extra c-sections don't save any mother's lives so must have been unnecessary.

But, fancy and interactive though that graph is, it tells us nothing about the optimal C-section rate. Firstly it says nothing about infant mortality, which is y'know kind of important (the Lancet piece shows a similar effect to maternal mortality but that's barely mentioned here). But it also gives no information about other bad outcomes. Death isn't the only thing that is worse than a C section. Certainly cesareans have serious down sides, but I'm guessing that women who've suffered for years with obstetric fistulas, or who have dedicated their lives to caring for a brain injured child, would probably think that one off surgery was the lesser evil. So without the data on these outcomes we can't say that 10%, 15% or any other figure is optimal (blimey, how many times have I said that on here?!)

The piece also tries to prove the pointlessness of all these C-sections by comparing the rates in economically similar countries - if there weren't loads of unnecessary C-sections going on how come there are twice as many in Mexico as in Costa-Rica? Or in Italy compared to the Netherlands?

But for me, that just hints at the point that has been so widely missed in this piece and so many like it. Certainly there are women who are coerced into C sections they didn't want and probably didn't need but what if in addition- just maybe, some women are making rational, reasoned decisions about their own bodies? You know, like proper grown up human beings? What if the differences between Italy and the Netherlands aren't entirely due to women doing what they are told by doctors but because there are considerable cultural differences between these countries and that may apply to women's attitudes to birth as well?

I'm speculating here of course but is it so utterly inconceivable that women should think a bit sometimes that it doesn't occur to the Economist to mention the possibility? Well except to trot out the same old tales of wealthy women choosing C sections to fit conveniently in their schedules or just to avoid traffic jams (seriously they say this)!

Like so so many articles it starts with the assumption that "as nature intended" is the best thing for all women's bodies. But in a world where we can eliminate diseases that once killed millions, where a woman might just be the next president of the most powerful country on earth and where a magazine can add an interactive infographic to the greatest and most accessible pool of human knowledge ever imagined, why is it so inconceivable that nature might not always know best on this one little thing and that choosing to do the unnatural might actually be ok for some of us?

Rant over, I need sleep, I'm taking MissE to Hamley's tomorrow (yay!!)

Tuesday, 21 July 2015

What I Want The National Maternity Review To Know

There is a lot I would like to say to you but it all boils down to this: Please listen.

Listen to as many voices as you possibly can. Even, no, especially the difficult ones. There must be no voices too hard to hear and no beliefs too sacred to be challenged.

Listen to the loud voices, the ones who come to you with years of campaigning behind them. But also seek out the quiet ones. The mums who don't write blogs or set up support groups, who's experience of maternity care was great or simply adequate. Find those who are silently trying to put a bad experience behind them or grieve for a baby who never came home. Those voices can be hard to find and harder to hear but if the review is to achieve it's true potential, they must be sought out.

Hear all these voices, the loud and the quiet, the angry and the joyful, with an open mind. I know that's hard. You all come to this review with your own knowledge and beliefs, born of personal and professional experience. How could you not? But try to set it all aside just for a little while and put yourself in the speakers shoes. Even if what they say runs contrary to all your own beliefs and experiences, they deserve to be heard, some might even have a point.

Listen also to the voiceless statistics, the dry scientific evidence from studies that can't hold anyone's attention the way a personal story can. They may still have something very important to say. Don't avoid them if they upturn a belief you hold dear, challenge them rigorously, but be prepared to change your mind if you have to. If the statistics and studies agree with you, then challenge them even harder.

Try for a while to quieten history. We know that historically human reproduction was filled with dangers. But we've come a very long way (at least in the developed world). Now the majority or us can assume we'll take home a healthy baby and be alive and well to care for it. But it's not just distant history that haunts us, the shadow of domineering male obstetricians who expected women to shut up and do what they were told, still looms. Though most doctors and women hold very different attitudes now. Then there are the choices which are now very safe but still viewed with the fear of the past. Pain relief, for example, has never been safer or more effective. Yet it is often looked on with concern or even a lingering biblical disdain that somehow women are meant to suffer in childbirth. If we're going to move on and create a maternity service that is both safe and compassionate, that offers both choice and protection from harm, then we need to shine a light on the here and now, not what used to be. We have never had so many good, safe, options but women must be made aware of them and when they make choices they must be respected, not caricatured as happens so often in our media.

Finally, listen to this - Thank you. I'm just an ordinary mum, nothing special but for what it's worth I am grateful to all of you for taking part in this review. I've experience both wonderful and dreadful maternity care on the NHS, I will be forever indebted to the people who brought my babies safely into the world but I know things are far from perfect and the challenges will only become more complex. Thank you for standing up and tackling that, I hope when the review is done your voices will be heard too and acted on by those with the power to bring about change.


For readers who don't know, The National Maternity Review was setup following the Kirkup enquiry into deaths at the Morecombe bay maternity service, I wrote about the Kirkup report here. I know of at least two other bloggers involved with the #MatExp group who have already written to the national maternity review do go and read this by Leigh Kendall and this by Helen Calvert.

Friday, 17 July 2015

Finally, MissE's Birth Story

I've always been in two minds about writing down the details of MissE's birth. In some ways it seems odd to share such an intimate and difficult story with whichever total strangers come across my blog. It is necessarily very long and I'm wary of producing a horror story or looking like I'm just fishing for sympathy. But her birth is also a huge part of why I write this blog and especially why I get so infuriated at stories that claim C section mums are weak or selfish. So, when I heard about a birth stories linky, I decided to have one more go at writing this down. Perhaps having a deadline is what finally got me through it. It's not a very happy story, (though there are far worse) and it is very long so I don't know if anyone will endure the whole thing. But if nothing else, putting it all down here has been cathartic and provides a record of events and perhaps an insight into why I write this blog.

A few days before MissE was born

Tuesday 2.33am

This isn't the story I hoped I'd write, although if you roll the credits at just the right moment, they both end up sort of the same. There are all the expected superlatives for that moment when you see your baby for the first time. She was beautiful, amazing, perfect and I was instantly hit by love so strong that it crushed me and lifted me to the sky in the same moment. But in The Other Story, the one I planned before her birth, I would have been holding her in my arms, in the midwife unit, perhaps in a warm pool of water. In this story, the real one, my arms were trapped, I lay on an operating table and the tale of how I got there was a lot longer and more complicated than I had imagined.

Sunday- Home

Both stories do start out about the same though. I know, almost exactly when the contractions started. It was 5pm. A Lot of people are unsure if it's the real thing, but I'd been having vague, uncomfortable tightenings for weeks and this was different, more focused and deliberate. I wasn't afraid, if anything I was excited and relieved. At nine days overdue in the August heat I was obsessed with when this baby would finally arrive. The previous Wednesday I'd gone to the midwife and reluctantly discussed the induction that my NCT teacher had promised would lead to a cascade of medical interventions and the one thing I was actually afraid of - a C section. It would also bar me from the midwife led unit and I was feeling pretty miserable about it all. Then everything changed to delight when I was found to be three centimeters dilated already and told to go home and prepare for labour. But labour didn't start on Wednesday night, or Thursday and by the weekend I was again resigning myself to the dreaded induction. So I welcomed those first contractions gratefully even as they got more and more painful.

I was also bleeding a little so I called the hospital who suggested I come in just to be checked. I knew I would probably be sent home again but it was only ten minutes away so we went along and after a short wait and a quick exam I was told all was fine and I could go home to get some food and rest. Disappointingly, I was still only three cm dilated but I felt good and couldn't wait to meet my baby.

Back home we ate pizza and (as recommended by that NCT teacher) I had a large glass of wine. The sleep though was more of a problem. While MrSB slept soundly next to me I was jolted back to consciousness by a contraction every time I was about to drift off. After a while I gave up and, with help from poor woken up MrSB, got into the bath. He went back to bed and I lay in the warm water, listening to whatever was on Radio 4 and keeping track of my contractions on a little clock by my feet. Getting in the bath seemed to speed things up almost immediately, the contractions were soon five minutes apart and quite strong. But the warm water in our extra deep bath made it bearable  and calm and after an hour I woke MrSB up again to say it was time to go back to hospital.

Monday Morning- The Midwife Led Birthing Center

It was odd driving though central London very early on a Monday morning, knowing that all around us millions of people were getting up, doing ordinary morning things and reluctantly preparing for another day at work, while we were about to have our whole lives changed. We had a longer wait in reception this time, I couldn't sit on the plastic chairs and it just seemed too bright and exposed. I paced up and down, worrying that the midwife unit was full and I would be sent to the labour ward or across London to another hospital. But a head finally appeared around the door and I was taken to one of the birthing rooms.

It turned out I had arrived, inconveniently, during a shift change. Initially I was assigned to the head midwife and her new student. I was fine with the student examining me and delighted when she turned to her supervisor smiling and said "ooh I don't want to say it!" I guessed what she was thinking, I was nearly there! All those hours, all those contractions, I was doing this, I could definitely do this!

But this is where The Other Story falls away.

The supervisor checked herself and shook her head. Three centimeters. Still only three.

In spite of that, they decided I could stay if I wanted as the contractions were clearly strong and frequent. I asked if I could use one of the birthing pools and was relieved to be told one was free but my senior midwife had gone elsewhere and the new one was dashing between me and another women who needed her more so I wasn't allowed to use the pool unassisted.

I tried to cope by keeping active, bouncing on a ball and firing up the booster on the TENS machine but I desperately wanted to be back in the water. The room had a little bathroom with a tiny half bath and in desperation I wedged all six foot and nine months pregnant of me into it. When the midwife found me, much later, she took pity and agreed to me using the birthing pool with just my husband for a lifeguard.

The pool however, was a bit of a disappointment. Perhaps I was just too tall for it but I found it hard to get comfy. It was better than being on land though and I breathed through each contraction, eyes closed, just letting them crash over me. I even managed to eat a vegetarian moussaka that arrived at what I think was lunch time, although in the dark windowless room I had lost all track of time. At some point the midwife came in and was able to stay with me. She sat quietly in the corner making notes while I bobbed about, amused by the surreal oddness of the situation.

Eventually, reluctantly, and with quite a bit of help, I hauled myself out of the tank, feeling the unwelcome return of the heft of gravity. We went back to the birthing room and I knew this time, I was nearly there,  nine cm at least? Surely? No, still three. Five days since the first examination, more then twenty hours of unremitting contractions and I had gone nowhere.

My birth plan said I didn't want anything to speed up labour. But my birth plan was written by someone else. Someone who hadn't been awake for almost 36 hours. Someone who wasn't, even after all that, still excited to meet her baby and sure it would happen soon.

So I lay on my back as the midwife inserted a hook and broke my waters. I hadn't minded all the other examinations but this time her head was right there between my legs as the amniotic fluid gushed out and I felt like I had wet myself right in her face. The indignity wasn't the worst thing though. The increase in pain was instant and huge. I was encouraged to walk now. I desperately wanted to be back in the comforting water, to rest in the warm, dark room. But I knew I needed to try something new so moved painfully down the corridor, stopping to hang from the wall or my husband's shoulders (oh thank heavens for those shoulders) with each contraction. In the little plastic garden at the end of the corridor some staff were eating their lunch, but quickly left as I bent over the window ledge for another contraction and the horrid gush of fluid that came with it. Outside people were sitting in the park, having normal days. How was that possible?

For two hours it got more and more intense. I'd been told that the pain went away completely in between contractions but it didn't. It was always there, along with the fog of exhaustion. The contractions obliterated everything, any thought I had was smashed from my head every few minutes, over and over and over again. I wasn't me anymore, the rational, sensible one, an educated women who rarely asks for help or gets emotional about things. I was an animal who knew only the sensation of pain and the desire to survive.

When I was examined again, I had only got to 5cm and I was defeated.

The obstetric unit was just down the corridor from the midwife unit, but it was the longest and hardest walk of my life. MrSB was ahead of me talking to the midwife and I lagged behind, stalled continually by the contractions. The midwife, shift number two or three at this point, had said that the next step was a  syntocinon drip to speed things up and that meant I had failed. I knew I couldn't keep going any longer and that to do so would be pointless anyway but I would have to leave the midwife unit, give up on my plans altogether and submit to all those scary things my NCT teacher had threatened. Having heard horror stories about syntocinon, I asked if I could have an epidural first. To my surprise the midwife seemed to be relieved when I said this and suggested I try some gas and air too so I could keep still for the epidural to be administered. Really, I'd wanted something for the pain for a long time, but in my confused state I hadn't wanted to ask for the gas and air, feeling I should wait for it to be offered.

Monday Night - The Obstetric Unit

The room was surprisingly similar to the one in the midwife unit but larger. I was given the gas and air fairly quickly and oh my god it was wonderful. I felt drunk. I was uneasy with the knowledge that I wasn't thinking straight, while everyone else was stone cold sober, but at least the pain was dampened enough that I could think at all. There was no anaesthetist available but with the new pain relief I was able to cope for another hour or so. When she was eventually free there were no drugs made up and so I waited some more while the ingredients were chased up with the pharmacy and carefully mixed.

Then they had to get the epidural in. This was where the really horrible experiences began. I was asked to sit sideways on the bed and bend forwards so the anaesthetist could put the epidural in my spine. But I couldn't bend, my belly was huge and I simply couldn't arch myelf into it. The doctor put the needle in, but missed the required spot. She had promised not to insert it during a contraction but instead she used that time to feel my bones and muscles, squeezing my back in a way that was absolute agony. I swore at her and she snapped back that she wasn't putting the needle in, after that I didn't dare complain again, there seemed no point anway.  I cant remember how many more failed attempts there were but eventually she got it in and I was hooked up to the epidural along with a cannula in my hand for the syntocinon (much later I learned from my notes that my spine is slightly twisted which is way it was so difficult to get the epidural in ).

Mostly I was just thankful that the process was over but as my right side began to go numb I felt a wonderful sense of release. It didn't actually bother me that my left side could still feel everything, I felt guilty about having the epidural at all and half the pain was still a lot better than all of it, so I didn't say anything. In a weird way I wanted some of the pain to remain, to prove I hadn't given in entirely. But after a while a midwife covering a break realised what was going on and moved me about until the drugs swept down my left side too.

It was bizarre, having been in so much pain, to suddenly feel tired but ok. I could tell from the monitor that the contractions were getting bigger and bigger but I couldn't feel them. At some point MrSB popped out and bought sandwiches and magazines, then I think he may have fallen asleep in a chair. I was too tired to read and too hyped up to sleep but I flicked through the pictures for a while. I was also able to walk to the bathroom initially, gingerly towing my drips and tubes, but after a few hours, and a humiliating attempt to use a cardboard bedpan, I was catheterised.

Finally, at around 11pm I was examined again. By now I was being looked after by two lovely midwives. One seemed confident and experienced the other was a trainee on her last shift. She was herself a mother of three and if she "caught" my baby, her training was complete. If we failed, she faced extra shifts. Also in the room was a doctor or maybe several. I'm not actually sure now how many people examined me, I was well passed caring anyway but to my absolute delight I was finally found to be fully dilated. I was told we would continue with the drip and wait another hour to try to get the baby to move down more and then I would push. We also agreed to stop topping up the epidural so that I would be able to feel what was going on and move around. Exhausted though I was, this was wonderful news. I could, after all, sort of, do this birth thing properly. But as the doctor left the room I heard him say quietly to the midwives: "don't let her push for too long, no more than an hour. She's on my list".

Tuesday - The Obstetric Unit

The hour ended at midnight. Now I knew my babies birthday, it would be today, this specific Tuesday. Without the epidural the pain was returning and I was finding it hard to think again but when the midwives returned a little later we set about bringing my baby into the world. At first they had to move me around. Hauling my swollen body and dead thighs into position after position and encouraging me to push with each contraction, but gradually movement returned and with it the pain. We tried more positions and a birthing stool but that just made me more aware of the discomfort from the catheter. I asked to have it removed but was told it had to stay. Back on the bed I was laid flat on my back with my lags in stirups, it was the complete opposite of what those NCT classes had said, but I'd done all the squatting, kneeling and bending already and that hadn't worked. I was also aware that, although the pain was back, I couldn't feel the baby, she still seemed high in my belly, and I had no urge to push, I just did it, to order on each contraction. At one point a midwife was next to me urging "come on, just one more push!" but it seemed impossible that that was true and the midwife confessed that it wasn't when I asked her. In a rare moment of assertiveness I told her not to say it again. It felt patronising and insulting, something you'd say to a reluctant child riding their bike up a hill, not to a grown woman who knew it was a lie.

Still I pushed and the doctors one hour deadline came and went. Perhaps the midwives really thought I could do it and wanted to spare me the alternative, perhaps they just wanted to be spared those extra shifts, either way it wasn't to be. I don't really remember when or why we decided to stop but at some we did. I think it must have been a midwife who made the final decision as I'd given up long before, but was too dazed to do anything other than carry on doing as I was told.

Then there were more people in the room, the doctor was back and other doctors too. They told me what I dreaded but, really, already knew. I needed a c section, the one thing I had been afraid of before all this began. A consent form appeared, and someone began reading me a list of risks: n% chance of a hysterectomy x% chance of a blood transfusion, y% chance of death. It seemed utterly insane to imagine I could make a reasoned decision, based on statistics at that point, were these people mad? Had they any idea how exhausted and confused I was? Was there really any other option at this point anyway? I asked my husband to tell me what to do and he told me to sign the form.

Tuesday - Operating Theater

A more urgent case needed the theater first so again I waited. The epidural was started again and I was given gas and air while I waited for it to work. But this time it did nothing. I screamed at the midwives that the pipe must be blocked but it wasn't. I was in what should have been the final throws of labour with (as I found out later) a huge, back to back baby. My contractions were made still stronger by syntocinon but all that I could bear, when I thought it would bring me my baby. Now I despised that pain. It was just so ****ing pointless, all that agony coming again and again and still I would be cut open and my baby removed by someone else. All that pain and still I couldn't do what millions of women throughout history have done and get her out myself. I can't begin to describe that pain, there are no words bad enough.  When the epidural did eventually return it only worked on one side again.

I don't remember going to theater. I have an image of lying there with machinery next to my head and a blue screen across my chest. The aneasthetist, a different one, was saying something about general anaesthetics and I was terrified that he was about to put me under, that I would miss the birth entirely and finally surrender the last shreds of my consciousness. But he was just asking questions just in case.

I was expecting them to get on with the surgery, at least then it would be over, but instead the surgeon decided to try the suction cap (ventouse). I couldn't see what was going on, I pushed to order again but I had so little energy left and no confidence it would work. Much later my husband told me how the surgeon had been using all his strength and weight to try and drag my baby out, bracing a foot against the leg of the operating table to add to the force. I'm glad I couldn't see that being done to my baby and I'm glad that I couldn't see what came next, when he reached in and tried to turn her head and twist her into a better position. But the ventouse had only managed to move her down far enough for her head to become firmly wedged in my pelvis, unturnable and unable to come down any further. Someone suggested forceps but the surgeon decided against that and now, with her head partially descended and trapped, the C section needed to be done quickly.

After that I have only snatches of memory.

I remember shaking violently and not knowing why, it was terrifying. In my confused state I thought I was hemorrhaging and going into shock.

I remember realising that I could see everything that was going on behind the screen in the reflection in a glass panel door panel. It was gruesomely fascinating but in the end I turned away.

I remember feeling sorrow guilt that my child would never have a sibling, I could never do this again.

I remember my husband looking over the screen as the baby was lifted from me and him telling me we had a daughter.

I remember silence, and the moments that seemed to last eternity as I willed her to cry and feared the very worst.

I remember having to choose if my husband should stay with me or go to our baby and sobbing as I was left alone so she would have one of us with her in these precious moments.

I remember hearing the surgeons talking anxiously about a bleed that wouldn't stop and feeling so afraid and exhausted and wretched that I didn't even care if it killed me.

I remember feeling like a slab of meat on a butchers block. 

There were strangers with my baby but I couldn't see her and no one was telling me if she was ok. There were strangers at my belly and they were cutting and sewing my body but they didn't think to speak to me. I was not empowered or elated by birth as I'd been promised by all those antenatal classes, hypnobirthing CDs etc. etc. I was merely flawed and inconvenient flesh.

Then, I remember a cry. A full blown, big lunged new born cry and a little while later, I saw my baby girl and felt that smack of love and all those superlatives of how wonderful she was. It seemed odd to see her for the first time, not naked, but wrapped in a towel, already in a nappy. I couldn't quite believe that something so astonishingly beautiful could have come from my wretched body and deliriously wondered if there had been a swap behind that blue screen, though I knew that made no sense. I was desperate to hold her but my arms were trapped under the blue screen and I could only look and yearn to touch her, as my husband held her near.

In recovery, with my baby in my arms at last

Friday July 17th 2015 - Home.

As I write this, our house is slowly filling up with Disney princess party accessories. In a few days we will celebrate my wonderful little girl's sixth birthday. I wish, when she asks me about her birth, that I could tell her The Other Story and that that first birthday was the happiest day of my life. But in reality, this is the story we have and those three days were the worst I've ever lived. So for now I'll skip the details and just tell her how loved and wanted she is.

This story will never be magical or inspiring but (I hope) it's not a horror story either. There were aspects of my care that weren't great and sadly, what followed on the postnatal ward was no better. But I know many people have it far worse and my overwhelming feeling looking back, is gratitude. In another time or place MissE would not be here, nor would I. Her little sister would never have even been conceived (her birth story is very different, you can read it here).

So difficult though the real story is, and so different from what I'd hoped for, it is what it is and there is no changing that now. MissE was worth every contraction, and every indignity and I would suffer them all a hundred times over for her if I had to. That's not heroic, it's being a Mum. In the end the stories end the same way and it's a very, very happy ending.

Me, MissE and her little sister MissM, camping in the woods

Friday, 5 June 2015

Should You Eat Your Placenta?

In 1998 Chanel 4 was was reprimanded by the broadcasting standards commission for a program in which a TV chef helped a new mother cook up placenta pate to serve to party guests. At the time it was judged to be a taboo and considered "disagreeable to many".

Things have changed a lot since 1998.

In 2012, when I was pregnant with MissM there were discussions on placenta consumption on many of the parenting chat forums, there were even fliers for a placenta encapsulation service in the waiting room of my hospital midwife clinic. It's certainly not common practice still. But it does seem to be growing in popularity and acceptance, egged on by the general trend to assume anything "natural" must be healthy and by a whole host of claims about the benefits.

But do those claims stack up?

Most advocates of the practice seem to base their assertions on the stories of those who believe it has helped them. They are usually something like this: "I felt awful after my first baby and developed post natal depression, after my second I took placenta pills/ smoothies etc. and everything was much better so the placenta must have worked." Well it might have, but every pregnancy, birth and postnatal period is unique. Second time around things may have been better wherever the placenta ended up.

Proper scientific evidence for the benefits of placentaphagy are harder to find. In fact a recent review of ten studies couldn't find any suggestion that the practice improved any health outcomes at all. The study has had a fair bit of media coverage so I'm not going to go into it in depth, I've also not yet read the full paper. But I do want to share a few other thoughts on the subject.

Having seen the fliers in that waiting room in 2012 I'd been interested enough to do a bit of research. I'd assumed that eating your afterbirth was a bit of a fad and rather pointless if you have plenty of other good food. But I'd also had a pretty difficult postnatal period last time and was desperate to avoid the same thing happening again. So, as this was being promoted in a prestigious NHS hospital perhaps there was more to it than I'd realised?

It turns out there was a lot I didn't know, but it only made me less inclined to sign up and chow down.

Incredible claims

There are apparently a range of benefits to eating your placenta including better recovery from childbirth, less fatigue, less postnatal depression and easier breast feeding according to at least one website it will also "tonify Qi, life energy" (er ok). But how all this is achieved is a little vague.

Certainly it seems likely that there is a lot of iron in a human placenta and anemia is common in new mums but there is also a lot of iron in a jolly good rare steak with a side of creamed spinach and the latter is likely to be considerably more pleasant to consume. Especially after months of pregnancy food restrictions. It'll also be considerably cheaper than placenta pills but i'll come back to that.

Iron, however, doesn't answer everything and another explanation promoted by many websites offering placenta services is stem cells. Now this I do know a bit about. The microbiome seems to be the new next best thing in medical research at the moment, but about a decade ago it was stem cells. These rare, primitive cells hold amazing regenerative potential and were once touted at the cure for almost everything. They are also, certainly, found in cord blood from the placenta. I've personally isolated stem cells from cord blood many many times and at certain hospitals you can donate these precious cells to be banked and used like a bone marrow transplant (you can also pay to bank them privately but that's a whole other blog post!). However, there is absolutely no evidence that eating stem cells would do you any good whatsoever. I'm probably more aware than most of the power and fragility of these cells. There is no way you could cook them, dry them and leave them wrapped in a plastic capsules for days or weeks and expect them to still be alive and capable of doing anything at all. 

What's the harm though?

Ok, so rationally, it's unlikely that eating your placenta will do anything at all, but if people want to do it that's their choice right? What's the harm? 

Well, actually we don't know. Various food standards bodies have raised concerns about the safety of placenta products. Often they are prepared at home by those selling their services and so there is little assurance that what is essentially a large piece of meat, has been handled and stored safely. The placenta, even if it were as magical as some claim, is not immune to bacterial contamination. In fact it probably comes with a good dose of bacteria and viruses from the start. 

Then there is the thing that really disturbed me. In researching this post I came across a few people selling not just placenta smoothies and capsules but also homeopathic placenta remedies. If the actual placenta does nothing then an extreme homeopathic dilution of some water that once contained some placenta is hardly likely to work either and I've seen absolutely no evidence for it being beneficial. Yet even more bold claims are made for this preparation. Not only will it apparently ease depression and anxiety in the mother it will also help babies with colic, teething and "illness".  

No, it absolutely will not help an ill child. This actually makes me angry because not only will it not help at all it could also delay the parent from seeking actual medical help it could be responsible needless pain, suffering and harm as the parent relies on the remedy they were told would work. If you're going to sell something and say it helps ill children, you should bloody well have some evidence that it does. If not. Back the hell off.

In fact if you're going to sell anything on the basis of health claims you really should have some decent evidence (and an awareness of basic biology that seems very lacking in many who sells placenta products). If a big pharmaceutical company started selling drugs based on a few anecdotes and stuff they read on the internet, without even doing any safety testing then there would be outcries and lawsuits and rightfully so. So why is it ok for those selling placenta services?

I don't think that there are any big corporations involved (yet) and I'm inclined to believe that all of the individuals selling their wares are doing so because they genuinely believe it will help. But that's not a good enough excuse. Pregnancy is an expensive and often vulnerable and anxious time. Placenta encapsulation costs around £150. Money that many could ill afford but might be persuaded to part with by the many grand claims made.

There seems to be no end to the products and services offered to pregnant and new mums these days. We all want to do the very best for our children and are prepared to make physical and financal sacrifices to achieve that. Placenta services play to and in some cases prey on this, offering no real benefits and as yet unknown risks. 

If you are concerned about depression, fatigue, breastfeeding etc. don't waste your money on placenta pills and smoothies. There is sadly no easy, natural quick fix to any of those issues. Talk to your doctor or midwife instead. Fight your corner if you have to, but make sure you get something that will really help. Not plastic coated wishful thinking.


Family Festivals 2015 - Feast In The Woods

or, Mum Unplugged.

Most of the time I revel in modern life. I’m just one of seven billion citizens yet each morning I pop on a watch with more computer power than an Apollo moon lander and go to work in a lab filled with high tech instruments and powerful lasers. All human knowledge is just a few taps away on a little device in my pocket and there is always something interesting to read, watch or learn. I don’t believe technology is somehow destroying human relationships, it can enhance them. My kids can dance in front of their grandparents even though they are hundreds of miles apart and I can chat with old friends on the other side of the world, in real time and without counting the cost of each second.  I also love London. Lots of people flee the city when they have kids but it can be a great place for families. You could do something new here every day for a lifetime and still not have seen or experienced everything on offer. MissE shares her classroom with kids of every colour and religion and while the rest of the country wrings it's hands over immigration policy, she sees only friends.

One of the labs at work (a form of high tech microscope) has a sign on the door which says: "life is fast and colourful" and it is. But sometimes I like to switch off, to take the kids out to a field or a woodland, disable the mobile data connection and spend a few days blissfully dirty and uncontactable. So both weekends this half term we stuffed our little car with tent, blankets and camping stove and headed off to festivals. You'll be able to read my review of Wychwood over at the wonderful Festival Kidz site (I'll add a direct link once the review is up) but the previous weekend was spent wild camping in Kent at Feast In The Woods.

MissE and I had been to Feast on our own last year after MissM came down with chicken pox and had to stay at home with MrSB. It had been a glorious weekend and I’d immediately booked for this year. But like meeting your heros there is always the risk that if you return to something wonderful, it might turn out not so good and ruin that first perfect memory. With the whole family along this year, including my mother-in-law (who joined us at the last minute as a birthday present) I was anxious that the weekend might not live up to my sales pitch. Those anxieties disappeared as soon as we had our tent up in the clearing though.

I think she was a tiger at some point

Feast is very small and tucked away in a private woodland with no roads. Most people there had children and it felt quite safe to let 5 year old MissE run off into the woods with the other kids. There were always parents about keeping an eye on things, but no need to hover over your own child all the time, which of course our little miss independance loved. The only problem was stopping two year old MissM (who can sniff out danger a mile away) from disappearing off with them.

This year there was a fabulous canopy over the firepit and in the evening we all sat around toasting marshmallows, making endless cups of tea from the communal kettle or popping to the cider barn for something stronger. I recognised a lot of people from last year and like us, many had brought along extra friends and family this time.

On Saturday, after the obligatory camping bacon butty, there was forest school. The kids set out to make a den with a bit of help from the parents (ok the parents had a great time and were very very proud of our the kid’s den). The rest of the day passed with an obstacle race, making bows and arrows and of course a lot of running, climbing and swinging in the woods. In the evening we all made bread on the fire. It was intended to go with dinner but we all of scoffed it immediately before our communal feast of local and foraged food. I had no idea barbecued spring onions could be so delicious!

On Sunday morning the sun shone and a group of us found a little patch of grass for a yoga session then we all headed to the lake for a barbeque. I’d been adamant I wasn’t going in the water this year but as the weather got warmer I grabbed my swimming costume and plunged into the freezing but very refreshing pool.

By mid morning on Saturday MissM crawled into the tent and crashed out for a few hours

We had planned to head home on Sunday evening but as a few rain showers got the tent wet and the covered fire was so very appealing we stayed for another night to finish off the marshmallows (and the contents of the cider barn). Poor MissE was in floods of tears when we finaly left on Monday morning, hugging her new friends, begging us to let her stay for the whole of half term and asking if we could go back next year.

Bamboo Trumpet

Coming back to London felt very strange. I walked across Peckham Rye common to some local shops in daze. In that wide open space the few people dotted about felt like a crowd, the traffic at the edges seemed alien and bizarre. For just a few hours I couldn’t connect back into the world and I didn’t want to either.

Later on I eased myself into it by making facebook friends with a few other Feasters and sharing pictures. By the next day I was back to getting the crowded commuter train, back to my busy job, twitter, blog, smartphone beeping and chiming with each virtual interaction. Then, with all this amazing, wondrous modern technology, we booked our tickets for next year.

This is how to deflate an airbed


Wednesday, 27 May 2015

Are Women Losing The Ability To Give Birth Naturally?

Or,  Has Michael Odent finally jumped the shark dolphin...*

Has something happened that is stopping women from performing the most ordinary but amazing act in nature? Well according to French surgeon and Obstetrician Michael Odent it has. But I'm not so sure...

Firstly big hat tip to Kiran Chug who has already blogged about this here, I wanted to write about this too and chip in a few of my very own opinions - I'm going to be quite ranty here I suspect.

Odent has just published a new book which is critical of modern maternity care and, it seems, modern mothers. Needless to say the Telegraph and Daily Mail are happy to share that. He believes that there are far too many births involving drugs or surgery. As a result of this, Odent says that the female of the species is loosing the ability to give birth as nature, or at least Odent, intended. I'll come back to some of the claims he's making in a minute. But first a few thoughts on the great man himself.

I first came across him when he was interviewed on BBC radio 4's Woman's Hour. At the time he was promoting the idea that men shouldn't be present at their children's birth. It would apparently interfere with the birthing process, upset everyone and ultimately lead to divorce.  Of course some men are appalling birth partners and are best kept away but others are a huge comfort and great practical help during birth. The thought of going through MissE's birth without F there is terrifying, I clung to him physically and emotionally and I don't know how I would have coped without him. So had Odent done a large and carefully controlled study to determine that actually dads made things worse? It's a pretty bold claim to make so there must be good evidence right?

nah, not so much.

As far as I can tell this is just his opinion. Oh and Odent sure has a lot of opinions. During the same interview he was talking about how safe childbirth is. He was then asked - if birth is so very safe, how come so many women and babies die in countries where there is little medical care? He just flat out denied that they do and for some reason the interviewer just moved on.

But Odent doesn't just deny suffering, he positively encourages it. He's also said that women shouldn't attempt to reduce the pain of childbirth with drugs because that pain teaches us a valuable lesson about the responsibilities of Motherhood. Which makes me wonder - I was in labour for 34 hours with a 9lb 10oz back to back baby, for some of that time I was on a drip to make the contractions stronger. It was f***ing agony. I also have a friend who's had 3 wonderful and very quick, homebirths. I got more pain - does that make me the more responsible Mum? Oh and how do Dads learn responsibility? Especially if they aren't in the delivery room for you to punch?

Odent is one of the pioneers of water birth and as such is often lauded by natural birth advocates for empowering women. But to me many of his opinions smack of old school (and he is in his 80's) patriarchal misogyny. Telling women how to give birth, releasing fathers from any responsibility and insisting that women must suffer to bring forth children. Are those really things to aspire to in 2015?

"To the woman he said, “I will surely multiply your pain in childbearing; in pain you shall bring forth children"
Genesis 3:16

And then we get to the real woo.

Odent is also on the editorial board of the deeply dubious magazine "What Doctors Don't tell You" (WDDTY). I've written about this before and in my opinion it is a horrible and dangerous publication. It advocates conspiracy theories and ignoring actual medical advice in favor of unproven or completely disproven alternative remedies. Which of course just happen to be advertised, for a price, in the magazine.

So my opinion on Odent?  I really can't trust anything he says. He makes grand proclamations based solely on his own beliefs, but uses his position and medical title to make them sound like facts. His involvement with WDDTY suggests he either fails to understand some pretty basic science or is happy to make money out of flogging dangerous nonsense (I'm really not sure which is worse).

But back to his current round of wisdom. There are a number of things that just don't make sense in the newspaper articles. He claims that an "insignificant number" of women now give birth naturally, but in the UK around 40% give birth with no drugs or interventions. That's hardly an insignificant number. Perhaps his definition of natural is a little more limited*?

He claims that an increase in the length of the first stage of labour between the 50's/60's and today is proof that women are loosing the ability to give birth properly but fails to take into account changes such as maternal age and obesity which are likley to play a large part in that. He actually seems to suggest that the use of artificial Oxytocin is causing an evolutionary change, a use ot or loose it effect, where natural production of oxytocin is disappearing. The idea that such a species wide evolutionary leap could be wrought in a couple of generations is bizarre.

Are there problems in modern childbirth? Absolutely, but I don't think any of those problems will be solved by one, publicity hungry, retired doctor, spouting off in the Daily Mail to flog a book. It only builds confusion and conflict. I also don't think we will make childbirth better by prescribing exactly how it should be done. Natural birth is a great choice for many but modern medicine has saved countless lives. The two must be balanced and women's choices respected. Many mums will want to avoid drugs in labour, others will want the very hurty thing to stop hurting and when there are good modern options with minimal side effects why shouldn't they make use of them? I don't think that having an epidural prevents your atonement for the sins of Eve and I don't think it'll turn you into an irresponsible mother either. It's just a choice and surely choice should be encouraged?


*Oh and the Dolphin/shark thing?...

The Quote is a bit hard to see but reads:  "This film explains why millions of women, all over the world, dream of giving birth in the sea, among Dolphins" - Dr Michael Odent

Perhaps this is why Odent Doesn't class that 40% of "normal" births as being properly natural, they just haven't gone far enough! I really hope this is a spoof but it seems like some people have extrapolated from Odent's idea for birthing pools to the point where they now advocate giving birth in the sea with "Dolphin attendants". Yep, what could be more natural than bringing your child into the world surrounded by cold saltwater, large marine predators and whatever other beasties decide to come along. I can't see anything going wrong there, oh no! All that's just my opinion of course, but at least I'm making that clear.

Friday, 15 May 2015

The Measles Vaccine - With Extra Life Saving Bonus

Or - why science is amazing and wonderful and cool.

Two things happened this week which reminded me just how fascinating science, and especially biology, (sorry Prof. Brian Cox) can be.

Firstly I gave a tour of our lab to some non scientists. I had 45 minutes to fill and it was a little daunting. Our lab is very specialised and technical, I didn't want to either bore them with incomprehensible science-speak or come across as some patronizing smart-arse. I think I pulled it off, and most of them seemed genuinely interested and amazed by our equipment and what we can do with it. I sometimes take it for granted that I'm involved in complex, novel research every day. So every now and then it's nice to be reminded that this isn't ordinary stuff to most people. Chatting to a colleague about it afterwards we both realised that - yeah, this is a pretty cool job, we can do stuff and find out things that would have been impossible just a few years ago and we're very privileged indeed to do that every working day.

The other thing I got chance to do was catch up on some reading. I worte some posts about Measles and measles vaccination a while ago but I'm by no means an expert on this subject and since then I've learned some new stuff. This is sort of a good news / bad news thing:

The Bad News:

I hadn't realised that getting through a case of the measles, as I did when I was five, didn't mean you were in the clear. There is a (thankfully rare) condition called subacute sclerosing panencephalitis (SSP) which can occur years after the initial disease seems to have gone away and which is sadly usually fatal. As I said, it's rare,  perhaps around 1 in 10,000 measles cases will go on to become SSP although the exact number is unclear and there is no specific diagnostic test for SSP, so it's quite possible that, since it could be 15 years since an SSP patient had the measles, the link might not be made. The good news here is that SSP is now very very rare indeed because vaccination means there are so few cases of measles in the first place (There is even an early episode of medical drama House where SSP turns out to be the mystery disease). But that isn't actually the main good news....

The Good News:

A new study suggests that the measles virus, as well as being potentially deadly and making you feel pretty damn miserable, also does a sort of factory reset on your immune system. By the time it's done you have good immunity to the measles but all your immunity to everything else is gone. All those immune cells that remember other, previous battles, against other diseases are wiped out. This means a fairly robust school child suddenly goes back to having the immunity of a vulnerable new born and in some cases it can take up to five years for them to get back to their pre-measles state. The study authors suggest that pre- vaccination, half of all deaths from childhood diseases were caused, indirectly, by measles.

Errr - how is this good news?

It is honestly  - hang on in there...
The reason we know this, is because it hardly ever happens anymore. Whenever measles vaccinations were introduced to a country the number of deaths from measles plummeted, but so did deaths from every other infectious disease too. Vaccinate against measles and you don't get measles which also means you don't get that factory reset of the rest of your immune system.

My immediate question was - how do we know it was the vaccine preventing the other deaths? Could it just be a coincidence? perhaps the vaccine was introduced at the same time as better food or sanitation? The correlation v causation question is always worth asking but in this case it really does seem to be the vaccine doing the job. The same dramatic fall in deaths is seen repeatedly in different decades and countries. Measles vaccination wasn't introduced to Denmark until 1987 but the same thing happened there, a rich, developed country. In fact the reduction in non-measles deaths is even more prominent in wealthy countries where most kids will survive measles and so go on to that susceptible period afterwards. Sadly in poorer countries many children never make it past the initial disease. Measles still kills 140,000 people a year.

This study also provides yet more evidence against some common anti-vaccination claims. Firstly there is the idea that catching a disease gives better immunity than vaccination. There is no evidence for this anyway but now we also know that catching the measles, rather than being vaccinated, actually wrecks immunity against everything else too.

I've also heard people claim that breast fed babies don't really need immunizations because they get all the immunity they need from their Mum. Breast milk does provide some immune protection although it seems to be fairly short term. But even if nature were as magical as some claim - one dose of natural measles virus and all that would be wiped out.

Biology is fascinated, there is always something new and unexpected, even when you have been studying and working with it for decades. Measles vaccination can now be considered one of the best and most cost effective health interventions on the planet. It's saved countless young lives and prevented a huge amount of suffering. But humans are pretty amazing too - we might not have realised how good it would be at the time but we made that vaccine and every scientist who worked on it, every health worker who delivers it and every parent who brings their child along has played a part in saving countless young lives.

I spend a lot of time on this blog saying "the press have hyped it up" or "the results don't really mean much" but we should celebrate our triumphs too. There is a lot of good news in science, a lot of genuine progress is being made. I wish more people could share in the complexity, beauty and wonder of it.