Friday, 4 April 2014

Birth Choice, Evidence and Squishy Biology



 


***Warning: The Following Post Contains Scenes of Gratuitous Statistics***


I like scientific evidence. I think that much will have become clear to any regular readers that I have. But what may also have become apparent is that it's not simple. Experiments and studies rarely give us definite black or white answers that apply to everyone. Biology is full of squishy things that just don't work like that.

I read a really interesting blog post recently by midwife Sheena Byrom who is fighting to improve maternity services and calling for better use of evidence in making decisions. I am all for that, but I don't agree with everything she said in her blog. So, rather than continue high-jacking her comments section, I decided to write my own post here.

The evidence in question is the Birth Place Study. This looked at a large group of pregnant women and where they planned to give birth (hospital, home, birthing centre). It then compared various outcomes of those births. The headline finding was good news - giving birth in the UK is very safe, wherever the mother chooses. But there is a slightly increased risk of harm to the baby for first time mums selecting home births.

Note: The difference was only seen in low risk first time mothers. Therefore this post deals exclusively  with this group. In addition, it was a UK study so the findings may not be applicable to other countries.

The Birth Place Study showed that for every 1000 planned home births, there would be 4 additional "primary outcomes" (I'll explain primary outcomes more in a minute, but they are a collection of bad things that can happen to a baby during birth). Byrom argues that this is a "small number", but that women are often only told that there in an "increased risk" and not given that number. She is also concerned that women aren't informed of the increased likelihood of interventions for those giving birth in hospital (such as instrumental delivery, emergency C-section etc) Therefore, she concludes that many women are unfairly scared away from out of hospital birth, and maternity services should be working to enable or perhaps encourage, far more first time mums to give birth out of hospital, to avoid all these "unnecessary" interventions.

It's a perfectly valid interpretation of the evidence but it's not the only one. Many of these "primary outcomes" are very serious. Therefore you could also argue that avoiding them is so important that the risk of extra interventions, although they are unpleasant and sometimes dangerous themselves, is a price worth paying.

So should we be working to get all first time Mums having home births or hospital? What is worse - a small risk of a major outcome for the baby or a larger risk of an intervention for the mother which could also have negative consequences? Can even a large and well conducted study answer this question?


What we need to know is - how much does home birth increase the risk of "primary outcomes", how much does hospital birth increase the risk of interventions and just how bad are all these outcomes and interventions anyway?

The information is all out there, but I've not yet seen it presented clearly, all in one place.

The main BMJ paper of the Birth Place study only gives the overall intervention rate for all mothers, but with a bit of digging I found the  Which? - Birth choice website  which gives the numbers for first time births only. This data comes from the online supplement of the BMJ paper (look for appendix 8.6 on page 70).*

Here, as simply as I can manage, is the data from the Birth Place Study for first time, low risk births. I have converted all the data into the how many per 1000 format:


Evaluating the risk - How likely is it that something negative will happen?



Harm to the baby


For 1000 mothers all choosing to give birth in the same place, this is how many of their babies would have one or more of the "Primary Outcomes" studied:


Hospital
Home
All low risk first time mums

5.3
9.3
Low risk first time mums with no complicating conditions at the start of labour
3.5
9.5


Risk of interventions 


For 1000 first time mothers all choosing to give birth in the same place, this is how many would have each kind of intervention:




Hospital
Home
Ventouse delivery
120
60
Forceps delivery
100
60
Emergency C-section
130
80
Syntocinon Augmentation*
300
160
Epidural or spinal anaesthetic
380
210
Episiotomy
280
150

*Syntocinon is a drip of artificial oxytocin, usually given to speed up labour

Total number of births that would NOT be considered "normal" (Normal birth is defined as birth without induction, forceps, ventouse, caesarean, episiotomy or epidural, spinal or general anaesthetic.)


Hospital 540 / 1000
Home 310 / 1000






How Bad Are those negative outcomes?


For the baby

The study looked at how many babies suffered what they called "primary outcomes". I've listed the outcomes they included in this below. The number in brackets is what percentage of the total number of primary outcomes each represents, eg. 30% of primary outcomes were meconium aspiration syndrome.

Still births and Neonatal deaths (13%)
Neonatal encephalopathy - disturbed brain function, usually due to lack of oxygen  (46%)
Meconium aspiration syndrome -inhalation of stool into the lungs  (30%)
Brachial plexus injury -damage to nerves that take signals from the spine to shoulders/arms/hands (8%)
Fractures to the humerus or clavicle -upper arm and collar bone (4%).

The small number of deaths are, undoubtedly, a tragedy. Any damage to the lungs, nerves or brain are very serious outcomes, although they may not always result in life long problems. Bone fractures, are very unpleasant but probably won't cause lasting issues.  So there is a considerable variation in how bad the outcomes actually are within this group. Thankfully they are all very rare, but this means the study authors can't give the figure for each individual outcome for each group. There just wouldn't be enough events to get a reliable number.


For the Mother


At the very least, all the interventions listed above can be unpleasant. They can cause increased pain or limit a woman's mobility during labour. Some can increase the likelihood of further interventions, for example, epidurals are associated with more instrumental (forceps and ventouse) deliveries. In rare cases there can be serious and long term effects. To try to stop this post getting too long I won't go into the pros and cons of each intervention but this information should be made available to women trying to make this decision.


It is also worth noting that not all women will want to avoid all the interventions above. For example, some may choose hospital birth specifically so that they have access to an epidural for pain relief.



Transfer Rates

This study grouped women by where they planned to give birth, not where the baby was was actually delivered. For first time mothers, 45% of those who wanted a home birth ended up being transferred to hospital. This is a very large number so women considering a home birth should also be aware of it.



Conclusion   Stuff From My Head


I'm really not in the business of worrying anyone here, the biggest finding of this study was that women in the UK don't need to fear giving birth.

Clearly, the increased risk associated with home birth for a first time mother is low. The risk of having some kind of intervention is much higher. This is true wherever a woman plans to give birth, but especially for planned hospital births.

Personally I was actually surprised that the increase in interventions wasn't even higher in hospital. I've often heard advocates of home birth state that unnecessary interventions are very common in hospital so I had assumed the difference would be many fold. But from this data, the biggest increase is a doubling in the likelihood of a ventouse delivery. The other interventions are slightly less than double, which is about the same as the increased risk of primary outcomes for home birth. That said, these are relative risks. The absolute risk of ventouse delivery increases from 60/1000 to 120/1000 for home and hospital respectively. Primary outcomes are rarer, increasing from 5.3/1000 for hospital to 9.3/1000 for home.

Having seen all these figures, I still don't think there is a clear cut correct answer. Once again, biology is squishy and what is right for one person may not be for the next. Overall the risk of serious, long term harm is very low wherever a woman chooses to give birth. So it comes down to each woman's interpretation of the remaining risks. This is personal and complex, depending on her individual history, her specific situation, and to a great extent her beliefs and emotions. No one can or should answer this question for her.


Squishy


So I wholeheartedly agree with Byrom that women should be given the information they need to make informed choices and that evidence should be used to shape maternity services. But I worry that the only people advocating this are those who want to see more home births or "normal" births. If there are women who want these options and, against the evidence, are being denied them then I absolutely support that fight. However, if the campaign is truly about maternal choice and using evidence, then shouldn't these advocates also be cheering on those women who feel safest and most comfortable giving birth in hospital? Who make a rational decision that they want an epidural, or even a C-section? With modern techniques these options could also be considered low risk and I don't believe that there is anything inherently wrong in women wanting to make use of modern science and medicine.

Also, rather than just giving up on hospital birth and heading home to avoid the interventions, shouldn't we be asking why there are more interventions in hospital? How many are genuinely unwanted or unnecessary and what can be done about that?

*09/04/14 - Correction. I originally stated that the BMJ paper only gave the intervention risks for all women and not for first time mothers only. Thank you to Jennifer Hollowell from the Birth Place Study team who pointed out that this information was given in the supplemental online material. I've amended the relevant paragraph accordingly.

SB

A Third Way
What I haven't covered here is the third choice in the birth place study, midwife led units. These can either be stand alone centres or alongside obstetric units and, from the Birth Place Study,  seem to offer the best of both worlds. The primary outcome levels are the same as for hospitals but the intervention rates are more similar to home births. Sadly it's not an option available to many women. I'd love to see more of these units but I suspect health authorities are unwilling to spend money on setting them up when the loudest calls are for home birth, which requires no major capital outlay.



Wednesday, 2 April 2014

Vote SouthwarkBelle



So, do you like the new look?

I live in a constant state of doubt with this blog. Does anyone other than me actually care about the things I rant about? Why am I spending so much time on this when time is such a rare commodity these days? Sometimes I consider jacking it in and getting a few more early nights instead.

These doubts are even stronger at this time of year. This is when nominations are happening for some of the parent blogging awards. Every year I look at them and every year I have decide not to enter. There has never been a category that I seemed to fit in. There are some amazing blogs out there and I certainly wouldn't consider myself to be Best Blog or Best Writer material, but the specialist categories have always been for things like food, crafts and fashion. All things I like (especially the food!), but not things I write about.

So why am I still here?

Because, just sometimes, some small but lovely things happen.

Some complete strangers read some things I've written and make the effort to send me a tweet, saying they'd enjoyed it and they agree with me.

A friend I've not heard from in a while, unasked, tells me she enjoys my blog.

One of the blogging awards gets some new categories.


So here I am with a whole new look and a resolution to continue. Thank you so much to everyone who has taken the time to read, comment, tweet, share, like etc. etc. over the years. Can I now ask you a favour?

Vote for me!

NOMINATE YOUR FAVORITE BLOGS

Please???

I would be so grateful if you could vote for this blog in the 2014 Brilliance in Blogging awards. Just click on the picture above and fill in the form, it'll only take a couple of minutes. I'm particularly looking at the Health and Commentary & Campaigns categories, but you can vote in as many as you like. 

This blog doesn't really fit in with the parent blogging world a lot of the time, but I am delighted to see the new categories the BiBs have introduced this year. It just goes to show how diverse the interests of today's parents are. Even if this goes nowhere and I don't even make the shortlist, it would be great to promote the blog a little bit more and to get something a little bit different entered into the awards. Maybe even convince a few more people that we parents can love cooking, crafting, clothes  and a good dose of sciencey stuff.

Thank you!

SBx


Saturday, 22 March 2014

The Best Mothers Day Gift

Bring Your Own Mum Night with NotOnTheHightStreet #BYOM





This is my Mum, and a glass a fizz. Sadly a bit of a rare sight around here, Mum that is, not the booze (ok, no, that sounds bad).

My Mum lives in deepest darkest Devonshire. I (and the clue's in the name here) am in South London. So taking her out for the night on Mothers Day never really happens. It's usually a case of a card in the post and a gift bought on line and sent directly to her. But last week I was lucky enough to be invited to the NotOnTheHighStreet Bring Your Own Mum event. NotOnTheHighStreet is exactly the sort of place where I normally hunt out those online gifts, the slightly unusual or more personal things that, I hope, can show love and a bit of effort, even at a distance. So, I jumped at the chance to go and Mum jumped on a train.

We'd been promised cocktails, nibbles and entertainment, but what was really nice was the first hour or so when (with the cocktails and nibbles), I could just have a really good chat to my Mum. These days our conversations usually happen via Skype with my four year old doing some kind of performance art and the toddler trying to find new and spectacular ways to injure herself. Needless to say not much actual talking happens, so a solid hour of grown up conversation is frankly a gift in itself!


Some of the lovely gifts on display - this bag would look great with my shoes if anyone is interested....
The big news of the night was that NotOnTheHighStreet are about to start selling experiences, but not your standard track day, spa day, air-balloon type experience.  As a taster we were treated to a quick trip through the history of fragrance by Odette Toilette, who passed perfume infused feathers around the room. From a rather over powering 1930's number, through nostalgic scents from from the 1970's,  to Anais Ansais  (a previous mothers day gift from me), and some I remember from my own teenage years - Bodyshop White Musk anyone?

Perfumed feather, and a rather nice cocktail

I was very excited to discover that our entertainment was comedian Shappi Khorsandi, who is always very funny. I could honestly now spend half an hour listing all the stuff that made me laugh but I'll just say she was a Mum talking about being a Mum to a room full of Mums. There is so much comic potential in that and she drew it out wonderfully.

So all in all a great night (apart from falling flat on my face on Oxford Street on the way home!). Great entertainment, lovely food, drink and gifts and the best present of the night - some time for a busy mother and daughter, to just sit and have a good old natter.



My only regret - I was too full for the cupcakes!



I am a member of the Mumsnet Bloggers Network Research Panel, a group of parent 

bloggers who have volunteered to review products, services, events and brands for 
Mumsnet. I have not paid for the product or to attend an event. I have editorial control and 
retain full editorial integrity




Wednesday, 19 March 2014

Magnets In Your Pants - Update




In case you missed it, a few weeks ago I wrote about some supposedly targeted twitter adverts, that had particularly annoyed me. Apparently, at the grand old age of 34, having had a baby just a few months ago (ok 16 months ago), I should be fending off symptoms of the menopause the "natural" way. What is the natural way to beat the menopause? Well it's obvious really, shove a plastic coated magnet down your under-crackers of course! What could possibly be more natural than that?

One of the people who commented suggested reporting the company to the Advertising Standards Authority (ASA). I didn't initially think it was worth it. I assumed that, although the claims made seemed rather misleading to me, the company would have spent a bunch of money on lawyers to ensure that they were carefully worded to be just within the rules.

But the adverts kept coming.

Even after I wrote a whole blog post taking the p*** out of the product, they were still trying to flog it to me.  So I responded in the most mature and sensible way I could think of. I sent a petty and sarcastic tweet in reply to each advert.

But still they came, daily!

Then, one afternoon I found myself watching a long but rather uninteresting experiment at work. I had four hours in a windowless room with only an internet connection to keep me entertained. So I filled in the online complaints form at the ASA.

How much good this has actually done I don't know but I have now been told by the ASA that other, similar complaints have been made in the past about this company and so their compliance team are taking on the case.

Will this stop the marketing of this kind of junk? No of course not, there is far too much money to be made from using plausible sounding nonsense to flog snake oil.

But you know what?

I've not had any of those ads in my twitter feed for at least a week. So, greater good aside, I count that a win!

SBx

Thursday, 6 March 2014

Do C-Sections Cause Obesity?

So this one was just bound to get me back into rant mode....

Last week I saw a piece in the New York Times blog (and many other news outlets), claiming that a new study shows babies born by caesarean are more likely to be obese as adults. There were the usual comments under it that "we are perfectly designed to give birth naturally*" so no wonder it's bad for the kid for these selfish mums have c-sections, blah blah. But, there were also a number of comments that made me smile. They were the ones that said - This study proves nothing; Corrolation does not equal causation.

It's a phrase I've come across a lot as I continue to dig into the world of pseudoscience that's hurled at us mums. So I thought it was time for a little post about it.

What the headlines would have us believe, is that being born by caesarean causes people to become obese. The paper does indeed show that those born by C-section have a slightly higher BMI, but you don't have to dig very far to find out that there is no proof that one thing is actually causing the other.

I'm going to wander off to another example for a minute, it gives me an excuse for a good graph. One of the main arguments in the early days of the MMR scare, was that Autism rates had increased enormously at the same time that the MMR vaccination was introduced. From this, some people concluded that the vaccine was causing the rise in autism. But MMR and Autism rates weren't the only things happening in the world at the time. For example - there was also a large increase in the sales of organic food:

Graph from Reddit user JasonP55

OMG organic food causes autism!!! No, no it doesn't, and neither do vaccinations, they are just three of the many things that happened to be changing in the world at the same time. There is a corrolation between autism diagnosis rate, MMR vaccination and organic food sales. But none of those things is linked in any way, except for in the conspiracy theories of the anti-vax world.

The other way you can get this correlation v causation issue is if two things are actually linked, but rather than one causing the other, they are both caused by something else entirely. Which brings us back to the C-section study.

Crucially, this study doesn't take into account the weight of the mother. This is a huge flaw** because of two well established facts:

1- Obese women are, for various reasons, more likely to have caesareans.
2- The children of obese mothers are more likely to grow up to be overweight themselves.

So are C-sections causing obesity? Or are the mode of birth and the babies subsequent BMI both just symptoms of the same cause - the mother's weight? The study can not possibly tell.

The author of the paper says: "There are good reasons why caesarean sections may be the best option for many mothers and their babies, and caesarean sections can, on occasion, be life-saving. However, we need to understand the long-term outcomes, in order to provide the best advice to women who are considering caesarean delivery”.

I have a couple of issues with that statement.

Firstly, it seems to assume that many women choose a caesarean for such flimsey reasons that an unproven risk of a small increase to their babies BMI might be enough to put them off. Whatever the likes of the Telegraph would have you believe, most C-sections in the UK are carried out for medical reasons. Either because of an emergency during labour, or because there is reason to believe it's the safest option for mother or baby. I can't imagine many scenarios where the slight increase in BMI is more worrying than the reason for the C section and of course, helping a child to develop healthy eating habits and an active lifestyle will go a long way towards warding off obesity. Regardless of how the child was born.

Secondly, yes, women should have the best possible advice. But this study is far too limited and preliminary to be part of that advice. In fact it shouldn't even really be news. It's an academic paper that suggests the need for further research in a specific field. But because that field is women's bodies and their choices about them, it makes it into almost all the major news outlets. This does nothing to make women better advised. Perhaps, with further work, it will be clear that caesareans really are causing obesity and if/when that happens women should absolutely be made aware of it so that they can consider it along side all the other factors. But at the moment all that this study and the media hype around it offer, is yet another reason for c-section mums to feel guilty and another bit of propaganda for the idea that the only correct birth is a natural birth. That isn't giving good advice for informed decisions. It's just another little way of preventing women from having control over our own bodies.

See - you all knew I'd get back to ranting soon didn't you?!

SB



*No we bloomin' well weren't. We evolved to be the best possible compromise between being able to walk upright and yet have babies with ludicrously massive heads. Weather or not you think a creator was involved in that is up to you, but either way it's compromise not perfection.

**This study was a review which collected and analysed data from other research papers. Another significant weakness is that most of those papers were very old dating from the 1930's to the 1970's. Caesarean birth was far less common in the past, and far riskier. It is therefore reasonable to assume that it was only done where there was a clear and significant risk of death or serious injury to mother and/or baby. This also means it's quite probable that mother and/or baby may have had other health issues and that these could have contributed to the babies increased BMI later in life.




Tuesday, 25 February 2014

First Day

This post is for the Save the Children First Day campaign, I wouldn't normally put up quite so many serious posts on my blog in one week, but this is a very important cause.



This is my eldest daughter, E on her first day at school last September:



Here she is on her first day as a big sister:


But those first days might never have happened.

E's birth was long and complicated, In the end, an instrumental delivery failed when her head became stuck in my pelvis and she was delivered by emergency caesarean. It was terrifying for me, but for the team of surgeons, anaesthetists, nurses and midwives in the specialist obstetric operating theatre of a major London teaching hospital, it was all pretty routine.

Had I been in somewhere else in the world, it could have been very different. We would never have had all those other first days with E.

It took the full force of modern medicine to save us, but staggeringly, every year, 2.9 million babies die in their first month, and many of them could be saved if they just had access to a local midwife or some antibiotics.

Just have a think about that number for a minute. 2.9 million.

The good news is, things can and are getting better. In 1990 the total number of children dying each year was 12.6 million. Thanks to family planning, better treatments for childhood illness, and of course global vaccination programmes that number had fallen to 6.6 million by 2012. But there is a lot more that can be done, especially in those vulnerable first days.

Here's now you can help, in just a couple of minutes, without even getting up from your seat.

First - click here to sign the Save the Children petition to ask David Cameron to use his influence over governments and wealthy business people. Ask them to work together and commit to ensuring every mother has access to a trained midwife.

Then, instead of buying that next fancy coffee, donate £3 to Save the Children. That's enough to buy ten tubes of antiseptic cream, which could be all that's needed to save the life of a newborn baby.



Thank you, normal ranting will continue at a later date...
SB

Monday, 24 February 2014

Response to BritMums Vaccination Post - By a ScienceMum

I'm writing this in response to a blog post on the BritMums site. In it a Dad declares himself pro-vaccination. Which is great, but for me the post doesn't go far enough and some of the comments that have followed have added to that feeling. So rather than respond to them all individually on the thread and look like I'm trying to high jack it entirely, I thought I would put up my own post here for those who are interested.

First up, If you are vehemently opposed to vaccinations, I know I have no hope of changing your mind so you may as well leave now  (or accuse me of being in the pay of Big Pharma* or something and then go, whatever) this post isn't for you.

This is for the many parents who just want to do the best for their kids, but have no previous experience in this area. Who try to do their own research and find they face a sea of contradictory information. I'm not a medical doctor and I'm not an expert in this field, but I am a scientist (and a Mum) and I have done a lot of research, over the years so I hope my opinions may be helpful to a few people.

(Also, I don't have a lot of time, so I'm just going to list a few of the comments on the post, and give my response, apologies if I don't link to evidence for what I say, I don't have time right now but if I can,I'll fill in the blanks later.)

Here, we go-

Some of the additives in vaccines are a bit "unsavoury":
There is a lot of talk about the additives in vaccines, much of it is plain nonsense. Either the "dangerous" ingredients are old ones not used any more or they may sound all chemical and scary but they have been used in millions of people for years without any real evidence of harm.
EDITED TO ADD: Often the additives are just used in such teeny tiny amounts that they pose no risk. For example, formaldehyde in vaccines sounds scary, but you'll get far far more of it from eating a pear then you will from a vaccine! As far as I know pears don't cause autism either.
 Here is a really helpful link to a more detailed explanation of additives in UK vaccines. 

Herd immunity:
This isn't really mentioned in the post but is touched on by a commenter. Choosing not to vaccinate your child doesn't just put them at risk. Yes if they are healthy then it's fairly unlikely that anything dreadful will happen to them without the jab. But they could pass a disease on to someone more vulnerable, a new born baby or anyone with certain medical conditions. If everyone eligible was vaccinated, the disease would simply disappear off the face of the earth as there wouldn't be enough hosts for it to keep going. We've already managed this with small pox and are very close with Polio. Diseases that used to kill and disable tens of thousands. Stuff the moon landings, this is one of man kinds greatest achievements.



Infographic by Leon Farrant data from CDC, 2011

The size of recent outbreaks means vaccinated kids must be getting sick too:
One commenter was worried about this, and it does seem to make sense if you assume the vast majority of kids are vaccinated. However, there are areas all over the UK where vaccination rates just aren't high enough. Take the recent Measles outbreak in Wales. Most babies are getting their MMR there, but a whole bunch of teenagers and young adults never had the jab as they got caught right in the middle of the (now utterly debunked) autism scare. Tragically, one of them died. You actually need a very high proportion of people to be vaccinated to get herd immunity. For Whooping cough, which has had a resurgence recently, and which can be fatal in newborns, you need up to 94% of the population to be vaccinated to keep those who are vulnerable safe.

Click here for an interactive map of vaccine preventable disease outbreaks

You shouldn't just blindly do as you're told - do your own research on vaccines:
Actually I agree, do do your own research. That's what science is all about after all, ask questions and look for evidence. But also question the evidence you get. Relying on scientific, peer reviewed papers isn't a perfect system. But it is by far the best system available. Anecdotes, magazine articles and yes - know it all blog posts are not the equal of a scientific paper. There are a lot of people who claim there is a conspiracy of government and big pharma, to hide the risks of vaccination, to make profits while cruelly endangering children. Yet often the people saying this stand to make a profit from you not vaccinating your child. Many have links to sales of alternative remedies or expensive private single vaccinations. Andrew Wakefield, who started the whole MMR scare was being paid huge amounts of money to produce evidence that would enable people to sue vaccine companies. He was also trying to develop and sell an alternative single vaccine. That someone would make false claims for personal profit is, to me, a more convincing story than that the NHS would conspire to pay for vaccines that would make loads of kids ill and cost them even more money!

Image is part of a great cartoon explanation of the Wakefield affair - Take a look at the rest here, it's well worth it

All drugs, including vaccines have side effects:
Yes they do. There are very few proven side effects to vaccination, but everything in life carries a risk so it's a matter of weighing up those risks. The question is - which is more likely to result in serious, long term damage to your child - a vaccination or an vaccine preventable disease? For the vast majority the risk of disease is far far greater.

My kids are healthy, why should I vaccinate them just to protect others?
It's a tricky question. Is vaccination an option or also a responsibility? In some other countries they take the latter approach and unvaccinated children are not allowed to attend government funded schools. Personally I'm uneasy with that but I am glad my children's jabs are also helping out others. Sure your healthy unvaccinated kid probably won't go deaf as a result of measles, but what if in a few years time they aren't so healthy? What if it's your best friend's, fully vaccinated child who needs to have chemo, looses all immunity and then gets measles? The outcome could be devastating. What if it's your own newborn who gets whooping cough from their otherwise healthy older sister? What if your kid is just one of the unlucky few who gets really sick even though they were fine otherwise. Just like kids used to all the time, before we had vaccinations?

There are plenty more common confusions over vaccination, and having read so much about it on the internet I can see why. If more comments come up on the Britmums post I may add them.

There is a whole blogging community devoted to trying to dispel these kind of myths, but it's one that rarely overlaps with the parent blogging world of Britmums etc. Regular readers of this blog will know that I'm in the process of making a few changes here and one of my main aims to to try and provide a link between these two blogging communities. There is a lot of nonsense out there, at best it is well meaning but inaccurate, at worst it endangers lives and preys financially and emotionally on the fears of loving parents. It assumes mums and dads are too stupid, too afraid or just have too little time (/sleep) to see through it. But I believe that "mummy bloggers" (and parents in general) aren't idiots, if we can only get at accurate information we can and will make sound, rational, decisions.

SBx

*I actually was employed, as a contractor, by big pharma for one year after I graduated. I didn't much like it and left to take up a less lucrative career with a charity. I have no remaining ties to pharma as far as I know.