Friday, 17 April 2015

D Is For Demons

A #MatExp ABC post

For those who don't know what the #MatExp ABC is:

Each day over on twitter, midwives, mothers, obstetricians and anyone else who wants to join in are sharing a word which is important to them and which relates to maternity care. I've been joining in and also trying to link my words to old blog posts, to give a more detailed explanation of my thoughts for anyone interested (some people seem to be so that's nice!). Today though I've struggled to find a post that puts it succinctly enough so I'm writing something new.


D is for Demonising

My NCT teacher had some pretty strong opinions about childbirth. She was a retired midwife and, understandably had a great deal of love and respect for her profession. Those feelings did not extend to her former colleagues with medical degrees.

We were taught that "normal", natural, ideally home birth was a wonderful thing and that it was achievable by almost anyone so long as we kept mobile, banished our fears and were helped only by midwives and doulas. But stray from her principles and horrors awaited us. There were doctors just desperate to turn our births into cold, medical procedures, soley to speed it up for their own benefit. Or because they were terrified of the minute chance that something would go wrong and they would be sued. If we allowed fear to creep in and agreed to pain relief or that first intervention, then we would surely be stepping off a cliff into an inevitable cascade of worsening tortures.

At most times I am quite pragmatic and rational, but I challenge anyone to maintain that after 24 hours of labour. With hindsight it made perfect sense to transfer from the birthing pool in the midwife led unit to the obstetric unit so I could let modern medicine help things along and get some pain relief and rest. But at the time it felt like an utter defeat, like I was surrendering my body and my will to whatever my sinister new masters dictated. I hadn't been afraid when I went into labour, as I moved along that corridor, towards the doctors and their machines, I was utterly terrified.

Being unafraid didn't prevent problems in my case, perhaps it does help others. However, those who seem in a position of authority, who present themselves as knowledgeable on the subject, should never try to remove the fear from one kind of birth by piling it onto all others. Most low risk pregnant women won't have to deal with doctors unless and until something goes wrong. So they have only other people's opinions of them to go on. If those opinions lump all doctors and all interventions together to be demonised - what does that do to the woman waiting for her first encounter with the obstetrician?

Wanting a "normal" birth, even if you have everything seemingly in your favour, can never entirely guarantee one. How much worse, then, is the fear of all those women who unexpectedly find they will need those demon doctors and tortuous medical acts?


D is for Demons

For a long time after MissE was born I carried my own demons. The ones who kept telling me I'd failed by having an emergency Casearean. Who suggested perhaps I just didn't try hard enough, that perhaps it wasn't really as necessary as I wanted to believe. For a long time I thought the only way to be free from them was to prove that I could do better next time. That I could give birth naturally and have one of those wonderful, empowering, birth experiences they were telling me I had thrown away. But those demons are gone now, and when it came to it, that wasn't what drove them out at all.

I didn't placate them by passing their test. My Demons were vanquished when I lay, calm and determined, on an operating table. My body was cut open by a man I had only just met, but I was not afraid or submissive. I had looked at all the evidence and all the options and I had chosen this. I had been taught that a woman's power in childbirth came from nature. But nature can be random and cruel, last time she would have casually watched me and my baby die. This time I decided not to leave it to her whims, I found power in the human creations of science and modern medicine and in myself choosing the safest way to protect my baby girl on her short trip into this world. As she arrived, the bright winter sun poured in through the window and I sent my demons flying out into it.


Saturday, 11 April 2015

The WHO Recommended Caesarean Section Rate (2015 Edition)

Yesterday the World Health Organisation (WHO) issued a statement about Caesarean sections- the title was:

Caesarean sections should only be performed when medically necessary

This was, of course, picked up by the press, with The Guardian pretty much copy-pasting the headline. So, does the WHO have some striking new evidence that there are far too many unnecessary C sections going on and it's endangering women and babies?

Well, no.

The statement comes with the publication of an article in the medical journal The Lancet. This looked at two studies into Caesarean section rates in 21 countries around the world. It found that overall the C- section rate was increasing everywhere (other than Japan for some reason). One of the main observations was that in countries where the Caesarean rate had been very low, maternal and infant mortality dropped as that rate rose towards 10%.  Here's a quote from the press release:

“These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “They also illustrate how important it is to ensure a caesarean section is provided to the women in need - and to not just focus on achieving any specific rate.”

But isn't there a WHO recommended C section rate? 

I've lost count of how many times on this blog I've used the phrase:

There is no WHO recommended caesarean section rate!!!

It is a much loved "fact" dragged up by every journalist writing anything about Cesareans (and in the press release and Guardian article) that the WHO recommends all countries should aim for a C section rate no higher than 10- 15%. Much less than in many developed countries including the UK and USA. It's true that the WHO used to recommend this, but they quietly dropped that in 2010 after they admitted the figure was based on no real evidence. It pretty much just seemed like a good enough number to someone so he went with it.

This hasn't stopped journalists continuing to drag it out at every opportunity though. Want to say women are choosing C sections because they are too posh to push, because they think it's an easy option, or because they are worried about their sex lives? Drag out that 15% figure to show how unnecessary all those caesareans are. Want to say that all these surgical deliveries are making babies stupid or fat  or costing the NHS a fortune? Be sure to mention that the WHO thinks a lot of C section mums are just being selfish!

So what does this new study really tell us?

Rather than setting a maximum C section rate, all this study can actually do is set a minimum. It shows that when a country's caesarean rate is below 10% then women and children will die needlessly. It also found that that once the C section rate got above 10% there was no further decrease in maternal or infant mortality. However, that doesn't necessarily mean that 10% is the optimum number (as suggested by the Guardian). The Lancet team only had information on mortality but death isn't the only possible serious outcome of a difficult birth. My family knows first hand the life long effects of a baby being deprived of oxygen during a difficult birth and, while it's almost unheard of in countries with good access to modern medicine, there are many women around the world living with horrendous obstetric fistulas. Is a 10% C section rate enough to prevent these? We simply do not have the data and without it, setting an arbitrary target figure is potentially very harmful. Which is why the press release, the Lancet article and this interview with one of the authors all make the point that the focus should be on ensuring every women who needs a caesarean has access to one and not on achieving some specific national figure.

But all this must of course be balanced against the risks of potentially unnecessary major surgery. The paper doesn't tell us anything new about these but the press release makes some general comments about risks and also highlights the lack of data on the social and psychological effects of a mother having a caesarean as well as the cost implications. The latter being particularly important for weak health systems where increasing the number of C sections draws resources away from other vital services.

The WHO has a very difficult job here. It is, after all, the WORLD Health Organisation and, as with so many health issues, there is enormous variation in the caesarean rate around the world. This is evident in the data from the 21 countries in this report. Among the poorest, C section rates are generally low, in Niger the rate rose from 5.3 - 9.8% over the period covered. In some of the wealthier parts of central and south America the C section rate is very high. In Mexico, by the end of the study period, it had reached 47.5%. Clearly not all of those Mexican C sections will have saved a life or prevented long term harm and I've heard from women in other countries with very high C section rates who felt they were coerced or forced into the surgery without a good reason. I have no doubt that this is wrong and should be acted on. But at the other end of the scale the WHO is also dealing with countries where women and babies die because of too few C sections. We simply don't have the evidence to set an optimum caesarean section rate that applies to every country in the world.

The Lancet review seems reasonably useful. It looked at a variety of factors and how they influenced C section rates in 21 quite varied countries (although I notice that no European countries were in the list). But I find the WHO statement and the Guardian regurgitation of it troubling; if Caesareans should only be done when medically necessary, then how to we define "medically necessary"? When the risk of someone dying is 50%? 10%? 0.001%?  Is a C section "medically necessary" if it won't save a life but will prevent a long term disability? What about a minor short term problem? What if the medical need isn't physical? Vaginal birth with all the attendant examinations and indignities can have serious mental health implications for women who've experienced sexual abuse. Then there are the women who've already had traumatic births or who are just plain scared.

That's a lot of questions and the Lancet publication can not possibly answer them. It doesn't even try to. So I find it worrying and bizarre that an organisation as important and influential as the WHO should extrapolate so wildly from a specific and limited data set. It looks like an attempt to shoe horn in something controversial in order to gain column inches. If so it's been successful.

But that still leaves me with another question - even if we could define and predict which Caesareans are medically necessary - should they be the only kind?

Don't get me wrong there are some pretty major downsides to surgical birth. It may avoid the pain of labour but the recovery can be long and agonising and it's major surgery. Things can go wrong. But according to NICE (the UK National Institute for Health and Care Excellence) the overall risks of caesarean section aren't much greater than for vaginal birth. It recommends that if a woman with no medical indication wants a C section she should receive counselling to explore her reasons but if she still wants a Caesarean birth she should get one.

In the UK where most of us have the luxury of taking it for granted that we and our babies will survive childbirth this seems like a reasonable position. I've had two caesareans, the second was my choice but I wouldn't recommend it to anyone with a good chance of a straightforward vaginal birth. However,  It's not for me or anyone else to make that decision about another woman's body. I don't think it's a great idea to have a C section without a pretty good reason. I really don't think it's sensible to have a home birth after multiple caesareans but women do make these choices and so long as she has made it herself, based on accurate information, then ultimately it's her body her choice. 

It's also worth remembering that all these percentages are describing national averages. They can say nothing about any of the scenarios an individual woman may face. Just because your country has a worryingly high C section rate, it doesn't mean your placenta previa didn't really require surgery. Just because your country's rate is so low it's costing lives it doesn't mean you won't have a straightforward natural birth.

There is no WHO recommended caesarean section rate and there shouldn't be. The Lancet article demonstrates this but the media have once again twisted the limited conclusions of a piece of research into an opportunity to attack women's bodily autonomy. Bizarrely in this case, aided by a WHO press release.

Statistics are useful and interesting for those in the relevant field. Numerical targets may or may not be helpful at the national level. But individual mothers and babies are far more important than any numbers generated from them.

Monday, 9 March 2015

10 (+1) Things Not To Say To A C Section Mum

Whatever the Telegraph may think, most Caesarean sections don't happen because "posh" women want to schedule them around their manicures or business meetings. They are usually undesirable, often unexpected and occasionally downright terrifying. I was lucky enough to come out of my emergency c section with a healthy baby, without the surgery the outcome would have been very different.

Yet still, I got some pretty unhelpful comments. Some were well meant, but in the fog of the situation they seemed to hint at something else, something I was already deeply troubled by - that perhaps a caesarean birth, maybe anything other than an all natural drug free birth, was seen as a failure. Others just came right out with that opinion.

Whatever your own beliefs about childbirth, there is absolutely nothing to be gained by making a woman feel bad about how her baby arrived in the world, especially not if it's only just happened. So here are my top ten things NOT to say to a C section mum and how they might actually sound to her:

1- What they say:
All That Matters Is A Healthy Baby.

What it sounds like:
It doesn't matter if you had a hideous time, shut up about it and stop being so ungrateful.

I was acutely aware of how lucky I was to have a healthy baby. But that isn't the only thing that matters. The future wellbeing of that healthy baby is symbiotically linked to the health of the mother. If she is physically or emotionally damaged by a traumatic birth, that matters to the baby. Oh and another thing - a mother is still a human being, if she is hurting that matters too.

2- What they say:
Oh what a shame

What it sounds like:
What a shame you didn't do it properly. What a shame you missed out on one of those wonderful "birth experiences". What a shame modern medicine saved your lives. (?)

3-What they say:
It's not really birth

What it sounds like:
You didn't give birth to your baby, he/she was just surgically extracted.

There was a baby in my belly, it came out of a hole in body. Therefore I gave birth.  It may have been a sun roof delivery and assisted by a surgeon rather than a midwife but it was still a birth and no less special for the angle of exit.

4-What they say:
You should have tried yoga, hypnobirthing, a doula, a waterbirth etc. etc.

What it sounds like:
You didn't do it right, so it's kind of your own fault.

Actually I did try all those things (well apart from the doula). They can be great and many women who've had straightforward births swear by them. But no individual can ever know for sure if it was the yoga/hypnosis etc. that made the difference, it could have just been good luck. None of these things offers a 100% guarantee. If dumb luck deals you a really bad hand then no amount of affirmations or pregnancy sun salutations will change that and plenty of women have perfectly straightforward births without any of them.

5-What they say:
I never thought that would happen to you!

What is sounds like:
I always thought women only have C sections because they don't try hard enough, are too posh to push or freak out at the first twinge of pain. I didn't think you were like that... but now I'm wondering if you are.

6-What they say:
It was probably an unnecaesarearn!

What it sounds like:
I don't believe that your C section really saved anyone's life. You were tricked into it by the doctors and too weak or stupid to stand up for yourself.

If a women tells you she had a life saving c section then to her, it was necessary. Perhaps is was possible that a vaginal birth would have been fine too, but if she decided to endure major surgery rather than take any risk with her own life or her baby's, then it was necessary to her. End of.

7-What they say
Let me tell you about my amazing home waterbirth...

What it sounds like:
Hey look at what you could have won if you were just like wonderful me!!

It's great that many women have had wonderful experiences of birth, but those of us who haven't really don't need them ramming down our throats uninvited. Many women feel a sense of loss at not having had the kind of birth they hoped for. Maybe in time hearing positive stories will be helpful, but it has to be about what the listener wants to hear, not what about the speaker wants to say. If a woman asks you to share your story, do. If not, shut the heck up for now and go find a facebook group to share it with.

8-What they say:
That's nothing, listen to my horror story...

What it sounds like:
Stop whining! What happened to me was way worse, you have no right to be upset.

There are no medals for childbirth martyrdom, there is no ranking system for who had it worst. A two hour labour may sound like a dream if you were in labour for days but for the woman concerned it could have been brutal and shocking. A C section may sound like an easy option if you endured a difficult forceps delivery and vice versa. If someone believes their experience was traumatic, then to them, it was.

9-What they say:
You'll always have to have C sections now you know.

What it sounds like:
You have no options now.

This might have been the case in the past but it certainly isn't now. The way the surgery is now normally done means the scar is quite strong and many women go on to have straightforward vaginal births. About 70% of VBACs (vaginal birth after caesarean) are successful. In some cases another Caesarean may be advised but most C section mums should have a choice over future births.

10- What they say:
Well at least you didn't have to have stitches!

What I say
Ok I know what you mean and yes, most c section mums won't have had to endure a tear or cut "down there", I know they can be pretty awful, but er, what exactly do you think is holding my entire abdomen together right now? 

oh and one last one, this may just be me though-

11- Well, I know it was a big baby but you're so tall it should have been fine!

Yes, I'm tall, but my baby was a whopping 33% bigger than the average baby girl. I'd have to be 7' 7" (232 cms) for the two to compare. But even ignoring that - here's the thing, er, the length of the mothers limbs isn't exactly the vital statistic here is it??

PS. Of course every woman's experience is different - do you have any more "things not to say" to add to the list? Do you disagree with any of mine? Comments are always very welcome!

Tuesday, 3 March 2015

Angels and Demons, Some Thoughts On The Morcambe Bay Scandal

I've been reading about the Kirkup inquiry into the deaths of mothers and babies at Furness hospital with great sorrow today. I wish I could also say I was shocked but I'm really not. I've not read the full 209 page document but one part of the executive summary really struck me.

"...working relationships were extremely poor, particularly between different staff groups, such as obstetricians, paediatricians and midwives; there was a growing move amongst midwives to pursue normal childbirth ‘at any cost’; "

There are many many wonderful midwives out there. Midwives who work tirelessly to care for women, to make their births safe and joyful experiences and who fight to improve services despite being overworked and under staffed. I've been lucky enough to be cared for by some of them. But in all the years I have been researching health issues around childbirth I've regularly seen two particular ideas being spread that worry me.

The first is that  "normal birth" ie. vaginal birth with no interventions or pain pain relief, is best. Targets should therefore be set to achieve more of them, individuals and entire services should be judged by the proportion of their births that meet these stringent criteria. Midwives (and others) who encourage women to have "normal births" are lauded. I've never been comfortable with this. Of course interventions are rarely welcomed and an unmedicated vaginal birth will be the best possible option for many women. But there are now many kinds of birth, both by choice and necessity. Sometimes the best possible birth is planned caesarean section, sometimes it needs an induction to get it going, sometimes a women may just decide that she is in dreadful pain, and as there is a really good, safe way to make it stop, she might as well use it. When so much effort is focused on promoting and achieving only one kind of birth there is surely a risk that all the others will be neglected. When people, especially midwives, publicly heap so much praise on this one kind of birth and endow it with benefits far beyond those that are scientifically proven, is it any wonder that many mothers who don't meet these expectations feel like they have failed and perhaps let down their babies? The best birth is one where mother and baby feel safe and well cared for, where both emerge healthy and there is no lasting harm, physical or emotional, to either of them. That can't always be achieved vaginally and drug free.

The second idea is pretty much a meme amoungst advocates of midwife led natural birth, here's just one example:

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Essentially, midwives are wonderful, nurturing women. Doctors are cold and uncaring men, devoid of human sympathy. They have no interest in mothers or their babies, and just want to get those births over and done with as quickly and clinically as possible (without any chance of getting sued). According to this belief, midwives and doctors aren't two medical professions working together , they are two utterly opposed ideologies. 

True, there are plenty of great midwives and a lot of rather aloof and callous doctors, but no profession is made up entirely of angels or demons. There are some pretty damned unsympathetic midwives out there. I've been on the receiving end of some of their "care". I've also met some lovely doctors, including two male obstetricians who showed enormous sensitivity when I burst into tears during their busy clinic and took great care to reassure me and give me options about my care. Not only is this "Midwife good doctor bad" meme inaccurate it's also does a huge disservice to the great many women who turn out to need care from a doctor. In the UK, a woman with a low risk pregnancy will normally only be cared for by midwives, both before and during the birth. But what if she turns out not to be low risk?  She will most likely already be worried about whatever that risk is. If she's also been taught to believe that the doctors she will have to deal with will be uncaring and even dangerous, how much more fear will that place on her? How much harder will it be for that woman to work with her doctor, and make informed decisions about her care, if she is expecting a fight before they even meet?

Sadly, at Morcambe bay these two ideas seem to have run to their extremes. Instead of working with doctors the midwives set themselves apart. They held the ideal of normal birth so high that lives were sacrificed to it. The individual midwives were not the only ones at fault of course. The doctors should have spoken out but they didn't and at many levels problems were ignored and hushed up for years. Mistakes happen, but these mistakes were systematically hidden away and so they continued to happen and more and more families faced going home with empty arms.  We only have the Kirkup inquiry because of the astonishing bravery and determination of some of those families, such as James Titcombe, who's baby son Joshua died of sepsis after a shocking lack of care which was then covered up. 

I absolutely stand with those who want to improve women's experience of childbirth. I owe a huge debt of gratitude to everyone who fought to move us away from the "do as you're told, doctor knows best" attitude of the past. I know that there are many wonderful midwives and that "normal" birth is the best possible birth for many women. But perhaps it's time for a little reality check. Midwives aren't all heroes, they are human beings after all. Exalting them as something apart from everyone else and from other medical professions might feel nice, "empowering" even, but it helps no one. Not the midwives who want to be great and what they do and who need to be able to learn from mistakes. Not the doctors, who have to deal with women who walk in their door already scared or angry with them. And certainly not the families, who need a kind and knowledgeable team to guide them through they most physically and emotionally demanding events of their life. 


Wednesday, 25 February 2015

Have Your Kids Had Their Smallpox Vaccination?

Have you vaccinated your kids against smallpox?


Why on earth not?

Oh, wait...

I've not given my kids the smallpox vaccine, I doubt anyone reading this has - why?

Because there is no more smallpox. Barring a few samples in two high security labs the disease simply does not exist anymore. Look it up on Wikipedia, it's talked about in the past tense. Measles is an infectious disease. Smallpox was an infectious disease

Why is it gone? Vaccination.

We don't have to decide if we should vaccinate our children against smallpox because we have absolutely no need to vaccinate them. We don't have to agonise over the possible side effects or if the vaccine may contain "toxins" etc. etc. We don't have to weigh up the personal choice not to vaccinate our own children against the greater good of protecting those who can't be vaccinated. We really don't have to think about it at all because previous generations did that for us.

They got vaccinated, they vaccinated their kids. It wasn't easy and many people had concerns about it. Doctors and health workers had to go out to the remotest parts of the world, through civil wars and famines to stop the last few outbreaks of the disease from spreading but in the end smallpox simply had no where left to go. There was no one left for it to disfigure and kill and so it died itself. In December 1979, just a few months after I was born, the whole world was declared free of smallpox.

We owe those previous generations an enormous debt of gratitude. So do our children and every generation to come. 

I starting thinking about this after reading this article on the WHO's reaction to recent measles outbreaks. I wrote recently about the Disneyland outbreak but I've only just heard about a bigger one in Germany which, tragically, has resulted in the death of an 18 month old boy who wasn't vaccinated. Overall the death rate from measles is thought to be around 1/1000. In Germany it only took 583 cases before a child lost their life to a preventable disease.

I also hadn't realised that the WHO had set a goal to eradicate measles from Europe and central Asia by the end of this year. A goal that now looks almost impossible. 

There is often a lot of talk about herd immunity in vaccine debates. If everyone who can have the vaccine does then the disease won't be able to spread to those who can't, such as new born babies, or those who have lost their immunity through disease or cancer treatment. But we tend to think of this as a very immediate thing. The current crop of small babies, people undergoing chemo this year. 

What the history of smallpox shows us is that we could do far more than that. If our generation pulls together, looks at the science and understands that the vaccines are very safe and clearly not linked to autism. If we ALL vaccinate our kids then it's not just them or their baby siblings and sick classmates who will benefit. It's their own children and everyone else yet to be born. 

If we do this now, our kids won't come to us concerned about vaccinating our grandchildren against measles or whooping cough or polio. They won't need to make that choice. Those diseases will exist only in history books.

Vaccination queue, 1962


Monday, 23 February 2015

Tech For Mums, The 13 Best Smart Watch Apps For Mums/Moms

So, now for something completely different.

Smart watches are part of the new wave of wearable tech, essentially it's like having a smaller version of a smart phone screen sitting on your wrist and connected to your phone by bluetooth. I wrote a while ago that I thought they would be ideally suited to women and especially Mums. Well, geek that I am I saved up my pennies and got one, I've been using it for a few months now and people have started to ask about it so time for a review (look away now if you have an iphone, you'll need to wait a bit longer for a compatible watch.)

Here's the context. I'm a working mum with a very chatty 5 year old and a very active 2 year old. Armies have gone to war with less stuff then I leave the house with to go to the park. I rarely have pockets big enough to comfortably carry my smartphone so if I'm out it is probably buried in the bottom of my enormous bag. If I'm at home I'm probably doing about 3 things at once and dealing with a constant barrage of requests or squabbles, organisation breaks down, stuff gets forgotten. A new watch can't fix that but with the aid of these apps it can help:

Best Apps:

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1- Find My Phone
Free, with paid for add on options
Hands down this is the app I use most on my watch. A couple of taps and you can make your phone ring so you can find it. It's not world changing technology but it is really very useful. It'll also make the watch vibrate if you are going out of range of the phone connection. Handy for stopping you forgetting your phone when you go out.

2- Google maps
I walk a lot, I have a hopeless sense of direction. Google maps on my phone has really helped with this but waving an expensive smart phone about while making it very obvious you are lost feels like an open invitation to thieves. It also isn't very easy if you're also pushing a buggy or controlling a rampaging toddler. With the watch integration I set up my route on the phone then chuck it in my bag. Every time I need to take a turning the watch vibrates and shows an arrow of which way to go, looking at it is just as quick (and discreet) as checking the time.

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This app lets you share your location with someone for a fixed period of time, they don't even need to have the app themselves. It works on the phone too but the watch app makes it super quick and easy to send a preset "Glympse". My husband and I use this all the time now, it's great if we're both racing to get to nursery pick up or wondering if it's worth holding dinner back for the other to get home. I also find it reassuring to know that someone can check where I am if I'm coming home alone at night, something which would be good for parents of older children too and it's less intrusive than tracking their every move.

4- Text and Email notifications
Built in
Not really a specific App but oh so handy. Waiting for an urgent message and annoyed by digging out your phone after five separate unimportant notifications? New emails and texts simply pop up on the watch screen with a little vibration to let you know. If it's important you can read it there if it's not simply swipe it away, it'll still be on the phone for later

5- Call notification and reject
Built in
Similarly any incoming phone calls will come up on the watch face with just a subtle vibration. Great if you are somewhere where it's inappropriate to have a phone buzzing but you still want to be able to receive that urgent call from school or nursery. Anything unimportant can be rejected on the watch and if you do want to answer, accepting the call via the watch buys you a few extra seconds to dash out of the room and and/or hunt in your bag for the phone.

6- Voice Texting
Built in
 The android wear watches use Google speech recognition technology so you can send a text to someone in your contacts without touching anything (or indeed an email or tweet) this has come in handy of any number of occasions, many of them involving pushchairs or hideous nappies. The voice recognition isn't 100% but it's pretty good and no worse than predictive text!

Cover art6- Google Keep
Keep is a very basic note taking app. More highly specked options such as Evernote also integrate with the watch but I prefer the simple sticky note style of Keep. As with the voice texting this uses voice recognition so you can make quick notes even if your hands are full (or filthy).

7- Timer
Built In
"ok Google, set a timer, 5 minutes" you say that to the watch, you get a timer. Simple as that. Good for cooking, (timing experiments if you're me) and possibly the naughty step!

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8-Google Fit
There are lots of fitness tracking and step counting apps available for smart watches. I particularly like the simplicity of Google fit which allows you to set achievable daily targets such as one hour of activity eg. walking or running, a day. It provides a little bit of motivation to get out and actually walk the school run when I'm feeling like being lazy and jumping in the car.

Cover art9-RunKeeper
If you are after some more serious exercise then there are a host of apps to for that too. I have the Sony SW3 which is the only one of the current devices to have it's own built in GPS. With the runkeeper app running on my watch I can track my run distance, time, speed etc without having to take the bulky phone along. I can also still listen to music using bluetooth headphones as the phone has 4G of memory. On other smart watches it would be necessary to carry the phone along still but it could all be controlled from the watch and while I'm running I also find it much easier to flick through music or check run times etc on my wrist rather than having to wrestle my phone out of it's pouch. Runkeeper is a little buggy on the watch at the moment but they are actively working on that in the mean time it may be worth giving a few others a go. Some of the other watches also have a built in heart rate monitor that some people might like to use when running.Free with paid for pro version

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10-Sleep as Android
Free trail with paid for add ons
Sleep oh sleep, how I love you, how I miss you. This app has been around for a while on phones but required you to have your phone in bed with you which I was never very keen on and as it relies on measuring movement it was easily thwarted by a memory foam mattress or a fidgety partner. None of these things are an issue if you use the watch as the movement sensor. The app will monitor your sleep cycles, to see how much deep sleep you actually get and the smart alarm system will try to wake you up when you are in a light sleep to avoid that awful alarm clock shock - unless the kids get there first of course! I've only had this a few days so can't comment on how accurate it is yet.

12- Wear Camera
This neat little app is a remote control for your phone camera. Open it and the phone camera will turn on, tap it to take a picture.

13- Google
You can put a web browser on the watch although the screen size limits it's usability, but voice activated Google searches are one of my kids' favorite things right now. My five year old asks my watch questions when we are doing homework, my two year old just like to shout "Polar Bear!" at it as this brings up a picture.

So This is my favorite toy of the moment, it's not going to revolutionise anyone's life but it really does come in handy at those times when actual hands are trying to juggle the world.

The downside for me (apart from the price of course!) is that at the moment none of the watches on offer are particularly attractive. Most go for either a sporty look or try to imitate a classic gents watch both of which are just a bit meh as far as I'm concerned. But there is the option to swap the straps on my Sony watch so hopefully a few prettier ones may emerge and the upcoming iphone has unsurprisingly made more of an effort in the fashion stakes. That said a couple of people have commented on liking the look of mine even without knowing it was a smart watch and of course being able to change your screen whenever you like is nice, my kids particularly like the animated Minion screen. My hope is that I'm not the only geeky mum out there who'll be helped out by this new technology and that if it becomes clear there is a strong female market the manufacturers will put in more effort to making the things appealing.

Finally a couple of FAQ's

What's the battery life like?
This varies between models but if I turn my Sony SW3 off overnight it will easily last 2 days without a charge. Certain things like using the inbuilt GPS will drain it faster. It also charges really quickly. I've not actually timed this but certainly less than 2 hours for a full charge which is good if you're using a sleep tracking app.

Is it Waterproof?
Again this varies but the SW3 is waterproof enough to go swimming in, and I've tested this out at a toddler swimming class!


Note - I got no freebies for this review, I paid for the watch and any apps myself, I'm just doing this in the hope it'll catch on and more great apps and pretty straps will be made!

Tuesday, 17 February 2015

Post Natal Care; My After The Birth Story

This post is mostly for the #MatExp folks who I have been trying to keep up with on twitter (it really wouldn't have fitted into 140 characters!) Heads up other readers this isn't a very happy or positive story, although thankfully we were ok in the end. If you are expecting a baby and anxious about postnatal care, you may want to skip this post, but don't go away there will be more ranting soon!


I started thinking about this after seeing a new report which shows that women in the UK spend less time in hospital after giving birth than our counterparts in any other EU country. This made me wonder- is this a bad thing? It is if women are being rushed out before they are ready just to clear the bed for the next person. A generation ago it was normal to spend a week in hospital after the birth of a first baby. Now, if it was straightforward, you could be home within hours. But many women are very glad of that, so perhaps the UK's short hospital stays should be welcomed?

Overall I suspect both aspects are at work, but for once I don't want to critique a study or the media coverage of it. I'm going to do something that is much harder for me and tell a very personal story about my own experience of postnatal care when my first child, MissE was born. I've touched on this before but never managed to put it all into text. It's long and upsetting and to be honest it's something I try to avoid reliving. I also know that I could have done things differently and spoken up for myself more, but at the time I was tired and traumatised from a very difficult birth and just wan't thinking clearly.

As a first for this blog I'm also going to put up a linky at the end and I really hope that other people will be able to share their own stories of post natal care,  good or bad.

So here's my story:

I arrived on the postnatal ward of a busy London hospital at some point on a Tuesday morning. I was oblivious to the time by then, days and nights had blurred together as the straight forward, natural birth I had planned (and foolish assumed was pretty much guaranteed), had taken me from wallowing in the birthing pool of the midwife unit to, eventually, lying shaking and terrified on the operating table. 

I do know that my daughter was born by emergency caesarean at 2.33am. Afterwards I was taken back to the delivery room for a few hours. I hadn't slept since the previous Saturday night, my husband had done a little better but was still extremely tired. He dragged out a sort of school gym mat that was propped in the corner and fell asleep on the floor. My beautiful new daughter dozed peaceful in her little plastic crib next to me. I was utterly exhausted, I should have slept but I couldn't. I'd been convinced of the very worst when my baby was whisked away, silent and unseen behind the blue surgical screen. But even once she was sleeping safely beside me I couldn't relax, I couldn't let go of the fear that something might happen, that someone needed to stay awake and watch her. At some point one of the midwives who had looked after me earlier in my labour popped in to say hello as she started her next shift. She'd been home, probably seen her family, slept, eaten. This was a whole new day for her but for me it was just a continuation of a timeless blur, I barely recognised her and couldn't speak to thank her for her help, whenever it was that she had helped.

I don't remember much about that day after I got to the postnatal ward. I was wheeled down on my bed, unable to move. The staff on the delivery ward all cooed over how beautiful miss E was with her full head of dark hair. I kept wondering if this was really my baby, I already loved her fiercely but how could something this beautiful have come from my ugly body? Had some switch been made behind that blue screen? I told myself that that made no sense, but still the doubts crept back.

I do remember that night though.

For a while it seemed that everything would be fine, I was the only person in a four bed room and at some point the lights were dimmed and I lay down, with one hand resting protectively on the tiny crib, and started to drift into sleep. I looked at the time on my phone, amazed I'd been awake for so long. An hour later I was woken up by voices and the clanking of equipment as another mother was brought into the room. I never learnt this lady's story. My best guess is that she was readmitted as her baby was jaundiced and had to be put under a lamp. Whatever had happened, the mother was clearly in desperate need of help herself. She spent the rest of the night pacing up and down the room, rambling and shouting, I couldn't make out what she was saying or in what language, I had no idea if it was directed at her baby, herself or maybe at me. With hindsight I know she was harmless, that I should have tried to help her but that's not what I thought at the time. At the time I felt extremely vulnerable, I still couldn't move and I was terrified of this "crazy lady"* and what she might do to me or my baby, the baby I needed to protect. So I did what I could and lay awake and vigilant all night. Once, a midwife came in and asked her to be quiet, but then they left us alone for the rest of the night. I should have called them, asked them to do more for my sake and hers but I was too scared that she would over hear me complaining and then take her revenge once the midwife's back was turned. Our room was at the end of the ward, out of the way and I had already learnt that the call button could wait twenty minutes for a response, if anyone came at all.

By now time had definitely returned and I was acutely aware of it. I watched the minutes and hours tick past, snatching glimpses of it on my phone screen, hidden under the bed sheet. Until it was just about morning and I thought it would be ok to call my husband. To shake him out of his much needed sleep and ask him to come back in the moment visiting hours began.

I remember a little more of my second day on the ward, there were family visitors, all delighted to meet the first member of a new generation, I felt the need to tell them all about her birth but I slowly realised, everyone was there for the baby. Not me. At some point we discovered that I still had a catheter in and the bag was full so it was removed, along with the cannula that had been tugging at my veins for days. I desperately wanted a shower but wasn't sure if I could, was it ok to get the scar wet? Would I even manage to stand in the room alone? Was I allowed? I managed it in the end, trying hard to get clean without actually looking at my body, trying to leave no trace of my blood in the shared bathroom.

By this point I'd been moved to a busier room, I couldn't help overhearing the conversations with the lady in the bed opposite. She had a new baby, just like me, but she had no where to take him home to and was waiting for a bed in some kind of hostel. How dare I complain in the face of that? What right had I with my lovely husband and nice flat to demand more time of the staff?

I remember the next night vividly too, far too vividly. Once again the lights were turned off and partners ushered out. But this time the ward stayed noisy. In the bed next to me another mum talked loudly on her phone, her TV blaring. She was told to keep it down but paid no attention. The bed opposite was briefly free until a new occupant arrived, her baby had just been born by emergency C section and her shocked and exhausted expression mirrored my own. As she was brought in I was sitting sideways on my bed, half naked, trying desperately to get a decent feed into my uninterested baby. I remember the look of horror on the face of the new woman's partner when he saw me. One of the midwives noisily changed the bed sheets, clanking the sinks and bins right next to me. I could feel again by now and the pain was growing. I pressed the call button to ask for some pain relief but no one came. Later I tried again, to get someone to help me lift my baby so I could feed her but again no one came.

Eventually the adults on the ward grew quieter just as the babies grew louder. I managed to flag down some pain relief but it wasn't enough and eventually, reluctantly, I was given a morphine tablet. I don't know if it was that or just the shear exhaustion but suddenly I began to hallucinate. At first it was just a little movement in the corner of my eye, down on the floor near the door - a mouse? Surely there wouldn't be mice running around the ward? If nothing else it was spotlessly clean. Then slowly the creature took the form not of a mouse but a moose, a cartoon moose that I used to draw at school. I knew it wasn't real but that only made it all the more terrifying, was I loosing my mind now? Would I soon be the "crazy lady" pacing the ward?

Still my baby wouldn't feed. For two days I been told this was terrible, or absolutely fine.  That there was something wrong with her mouth or she just needed a rest. But I needed to feed her, I had to make her ok and do something right for her, but she just wouldn't, what was I doing wrong? I wanted help but couldn't ask for it, no one seemed interested, every bit of advice I'd had contradicted the last and besides, I really shouldn't make a nuisance of myself.

Eventually it all became too much and I allowed the tears come. But it wasn't the quiet restrained little weep I had expected. It was the gulping, sobbing, unstoppable cry of a small child, I knew everyone could hear me but once I had started I couldn't haul back any control. After a while one of the midwives came over and asked what was wrong. For a moment I thought she would help me, that she would do something, so my baby would feed and I could sleep. Or she would just just tell me that yes, what I'd been through was horrible and I had every right to feel shocked and upset by it. But no. She told me sharply that I must stop crying and making a fuss or I would spoil my milk and not be able to feed my baby at all.

Then she left.

I should have called her supervisor, I should have complained and asked for help. But I didn't. Instead I listened as the supervisor (who I think was informed of the incident by another of the mums) and the midwife argued about her behavior in the corridor outside. The midwife then stomped off leaving the rest of the staff chatting about last night's TV. The supervisor did briefly come over to check I was ok but didn't mention the incident. Neither did I, I knew better than to ask for help now.

Not long after that the baby screaming really kicked off, my own alternating with one of the others in the room so that it was a constant din. I had to get out of there, I staggered to the desk and asked if there was anywhere I could go to be alone with my baby and away from the noise. Someone waved in the direction of the ward lounge, but it had dazzling automatic lights that left me feeling exposed so I asked if there was anywhere else and was pointed down the corridor to to a little room used for expressing milk.

I spent the rest of the night in that small, beige, rectangular room. There were two big machines and a plastic chair. MissE slept on and off in her crib or in my arms, though I was scared I might finally fall asleep and then drop her. Mostly I sat on the plastic chair, alone in the dark, checking off the minutes and hours on my phone until morning. When I thought it would be getting light outside I went back to my bed. No one checked on me, no one noticed I'd been gone for hours.

All I knew now was that I needed to leave. Yes I had had major surgery and my baby wasn't feeding well, but there was no way either of us could recover there and I doubted my body or mind would hold out for another night. I lay on display in my bed as the doctors and midwives did their morning ward round, discussing me as if I wasn't there, ignoring my attempts to join in the conversation about my body and it's failings.

It took hours and a lot of nagging but eventually, against the advice of the medical staff, I left. Shuffling painfully down the corridor, not fast enough to get to the room where my baby was having her first checks, but I made it out, using our new pram as a walking aid.

It was Thursday afternoon, I'd slept for a total of one hour since the previous Saturday night. I had been through an exhausting labour and emergency surgery, followed by two nights awake and afraid. I felt broken in every way and now, I had to go out and become a mother.


Thankfully this was all more than five years ago now and that precious little baby is now a vibrant, chatty schoolgirl. We moved a few months after her birth and so her little sister was born at a different hospital and, although the postnatal stay was noisy, I was cared for with warmth and respect. My husband was able to stay with me all night and one of the midwives happily took my baby away for a cuddle so I could get some rest. I woke up hours later to find a my little one, wrapped cosily in a blanket my Aunt had made for her, fast asleep in the crib next to me.

So what would make postnatal care better? In an ideal world, we would have individual rooms, so mothers had some privacy and only their own baby's crying to deal with. There would be plenty of midwives popping in to check everyone was ok and partners would have at least a good comfy chair to spend the night in.

Of course that may be impossible for many hospitals but there are things that could be improved for very little cost. Simply checking if a woman has any questions about what to do now would be a start. Is it ok to shower? To eat? Should she be up and walking about or taking it easy in bed? Is it ok to lift the baby? Even a really big baby? What about pain relief? When a birth hasn't gone to plan a woman may be completely unprepared for the aftermath. I did virtually no research into C sections as I never thought it would happen to me, so I had only old, outdated, second hand information to draw on.

Consistency is also a big thing, I got completely contradictory information about breast feeding, my very large baby simply wasn't interested at the start. Some of the midwives were unconcerned by this, others terrified me with the possible consequences of letting her sleep, unfed for more than two hours at a time.

Then there is kindness, that costs nothing, not even a great deal of time. The midwife who told me I would spoil my milk should not be in that job, I don't care how busy or stressed she felt, there is no excuse for that.

Second time around, the hospital was just as busy as the first, the staff no doubt under just as much pressure but what really made the difference was just a few snatched moments of kindness and empathy. A quick smile and acknowledgment that I was a person, not merely the occupant of a bed, or the vessel from which a baby had been removed. Even when resources and time are acutely limited surely that can be achieved everywhere?


* I don't use the phrase "crazy lady" lightly, and I certainly hope it doesn't cause anyone any offense, it is just the best way I can think of to describe my perception of her at the time.