Wednesday, 16 September 2015

Why It's Not Science V Nature

Getting back to nature seems to be increasingly important to many people. Wander about health advice on the internet or in print and you'll soon find stories about how eating, living and parenting like our wilder ancestors will make us happier and healthier. That we can, if we learn from them, get back to a time when our lives were simpler and free from the fatigues and stresses of the world we now inhabit. Take a detour to the more judgey end of parenting advice and you'll be told that failing to be natural, to breast feed, baby wear, co-sleep etc, will lead to irreparable physical and psychological harm. These are powerful promises and they breed powerful desires. When faced with a medical system that often can't explain, never mind cure, our maladies, alternative remedies and restrictive diets offer the tantalising promise of control. Of actually being able to do something for ourselves.

Although there is little, if any, good scientific evidence for many of these claims they do feel desperately appealing and intuitively correct. The lack of cold, hard, modern science, if anything, seems like further proof that these alternatives are better, kinder and more holistic. I keep seeing articles and comments which assume that science (and often modern medicine too) is divorced from nature. That we scientists have set ourselves apart by obsessing over percentages, chemical formulas and our own powers and in so doing we've become blind to the simple truths offered by nature.

Science stands alone and aloof at one side of the room. Nature, art, beauty and creativity are at the other.

But that's not how I see it. It was a love of nature that drew me to science in the first place. As a child I devoured BBC natural history programs that brought biology into my home through innovative technologies and presented it like works of art. I was fascinated by dinosaurs, owls and strange, exotic animals. I learned how these creatures interacted, how ecosystems depended on impossibly intricate webs of connection, containing everything from tiny insects to giant predators. I dreamed of going on pilgrimage to the Amazon rain forest or Galapagos Islands so I could see these wonders first hand. As I got older I also found that sense of wonder in the human body. It seemed (it still does) that every time I learned something new it only revealed another layer of complexity, another set of questions that I had no idea existed. Once you understand the organs of the body - what about the cells that make them up? Then there are the different components of those cells - what do they do? How are they powered? What are the individual molecules involved? The atoms?

I am a scientist, not because I deplore nature, but because I am in awe of it. Learning something new about how our bodies work is, to me, like experiencing a great work of art. It can be emotional and beautiful, it can teach us truths about life and humanity, while also challenging us with new questions. Physicists may search for the Theory Of Everything but in biology it's the very fact that we are no where near understanding even a fraction of everything, that makes it so fascinating.

This doesn't, however, mean that I see or seek perfection in nature. Working in medical research it's easy to find examples of what can go wrong. The complex DNA blueprints in our cells are copied and repaired perfectly, billions of times in our life, but it takes just a handful of little errors, a few misspellings, to set off a fatal disease process. Sometimes those errors are the result of our modern way of life, tobacco smoke for one, is undoubtedly dangerous. But more often these little mistakes are utterly random. Nothing, not even nature could create something as complex as a human being and make it flawless. To get back to this blog's pet topic for a moment, that's why I hate it when people say we humans are "perfectly designed for childbirth". We aren't perfectly designed or even perfectly evolved for anything. We are a fantastical compromise, a phenomenally intelligent mammal which can run for hours on just two legs, yet still get our babies' enormous heads through the twists and turns of our altered pelvises. Evolution, nature, does not require that compromise to work for everyone, it doesn't produce perfect finished products. The benefits to our species of being clever and keeping our hands free for tools are so great that nature is happy to sacrifice the mothers and babies whose unusual pelvis/ big brain combination just doesn't work. Nature is ok with a bit of collateral damage.

Of course I don't speak for all scientists, or even all biologists. There are scientists who show little empathy for other people or the natural world, who cheat and fake results to get to the top, who act unethically or just aren't very nice human beings but that is true in any large enough group of people. It is, sadly, human nature. But speaking for myself, nature is not this scientist's enemy. It is flawed and complex and much of it is beyond my comprehension but this is why I am a scientist. Because I never want to stop asking why? how? and what went wrong?

Like most people I would love to get rid of the lingering fatigue of modern life. I am tired and sometimes things hurt. I wish I were slimmer, happier, more energetic, less stressed and a dozen other things. I wish I could achieve all that by tapping into ancient wisdom, by eating like our caveman ancestors or breastfeeding my toddler. But as a scientist I reluctantly concede that it just isn't that simple, nature isn't that simple. So I will continue on, dressed in my health and safety protection gear, surrounded, unnaturally, by millions of pounds worth of droning and buzzing high tech equipment and maybe I will contribute just a tiny bit to our understanding of nature. There are no simple cures, there was no golden era before science, when humans bursting with vitality lived joyfully at one with nature. But Science is not nature's opposite or opponent. Science glorifies nature and in so doing, in slow tentative steps, we might come to understand what ails us and perhaps how to fix it.

Most scientists are just ordinary people. We juggle work and family, try to follow our passions and leave the world a little better than we found it. Sometimes we wish life were simpler or we felt healthier and sometimes we just wish that we could get away. That we could stand alone on a beach, with the sun on our skin and stare out at the mysterious depths of an ocean. Or sit in a forest surrounded by the sounds of birds and trees. Just like our ancient, natural, ancestors did.

PS I did go to the Amazon and the Galapagos Islands. They were even more amazing than I'd imagined.

Wednesday, 9 September 2015

Have Your Say In The NHS Maternity Review

A big review of NHS maternity services is currently underway and those involved are actively seeking out the opinions and experiences of Mums and Dads. This week they launched an online consultation which you can access here:

If you or your partner/friend/family member has had a baby with the NHS please please take a few minutes to fill this in.
I am eternally grateful to the NHS, in another time or place MissE and I wouldn't have made it or if we did, the cost would have been crippling. But my first experience of bringing a child into the world was, to be honest, pretty hellish. I hope one day my little girls will become mothers and that when they do the NHS will be there to help them, but services need to improve, as a minimum women must feel safe and respected, currently that isn't always the case. Money is tight but improvements can be made, I had a pretty positive experience with my second pregnancy and much of that was thanks to actions and attitudes that cost nothing.

But you don't need to be passionately interested, or actively involved in maternity services to take part in this review. It doesn't matter if your own experience was great or terrible or just a bit meh. If this review is to do anything then it needs to understand the full spectrum of NHS maternity experiences and actually I suspect it's those who fall somewhere in the middle, who's care was ok or quite good but not amazing or terrible, who are least likely to speak out. Yet those experiences are valuable and important too.

 It's vital that the review hears as many different voices as possible. They are of course talking to doctors, midwives, charities and campaign groups as well, so there are a lot of strong voices joining this discussion. But as I wrote at the start of the review, it needs to hear the quiet voices too because the loud ones may not speak for everyone.

PS. I'll be filling it in twice as my two experiences were so different!

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