Monday, 8 September 2014

Induction - Cascade - Caesarean Section

It's well known fact of modern childbirth: Inducing labour sets off a cascade of other interventions which often lead, with grim inevitability, to an emergency C section.

But is this actually true?

 - Firstly, hat tip here to This Blog - I'm writing my own aimed at people who probably aren't regular readers of Scientific American (confession, I'm not either) and because I have one or two opinions ...

When I went overdue with MissE I dreaded being induced. I'd heard nothing but horror stories and  according to my NCT teacher it was basically entirely awful and unnecessary. It would also completely scupper my plans for a natural birth in a midwife led unit. But at the same time I was BLOODY MASSIVE. It was August, and hot, I was desperate to meet my baby and had had quite enough of being pregnant. So I agreed to booking an induction and did everything I could think of to make that booking unnecessary*. In the event I got my wish (although I still ended up going through much of the induction procedure after 24 pointless hours of contractions... but anyway)

41 weeks. Bloody Massive

So was I right to fear the induction? It seems the answer to that is no.

A recent study has shown that being induced doesn't increase the likelihood of having a caesarean. In fact women having a single baby, who are induced at term or when overdue are slightly LESS likely to have a C section than those who hang on for nature to do her thing. They are also (again, slightly) less likely to have a baby who dies or who needs to be admitted to intensive care.

This goes against so much other information - Can we really trust this new study?

We often see piles of scientific studies that contradict each other, one minute coffee causes cancer the next it cures it etc. etc. so how reliable is this one, given that it goes so strongly against the generally accepted view?

In this case the authors of the paper didn't set up their own experiment or trial. Instead they did what is known as a meta analysis. This is important because a meta analysis is far more reliable than most of the scientific studies that make it into the media. The authors took the data from 157 different trials and did some serious number crunching. Looking not just at the results of those trials but at their weaknesses too. For example, many of the individual trials were pretty small, meaning their results are less reliable than bigger studies. By putting all this information together they are able to overcome most of the errors and biases that inevitably influence the results of individual studies. We rarely find perfect answers in anything associated with biology, but a meta analysis is about as good as it gets.

So now what?

The differences seen are fairly small, they certainly don't warrant more or earlier inductions but they do call into question the generally accepted view of induction.

Here is what the NCT, the UKs largest parenting charity says about induction on it's website:

Induction of labour may set off a ‘cascade of intervention’, and before you know it you may be drawn into having drips, electronic monitoring, epidurals and all the trappings of a medically complicated, high-tech birth. If you go two weeks past your dates, you can ask to have regular checks on the baby rather than have your labour induced.  ...

 Other methods you may want to consider are acupuncture, hypnotherapy, reflexology and shiatsu. There is no clear evidence that these methods work, but they may be worth a try.

This was written before the recent study was published, but it is a good example of the prevailing view of induction. That it is something to be avoided, even when doctors recommend it and that it's better to go with completely unproven* (actually disproven may be better) and generally quite expensive alternative remedies, rather than risk the dreaded descent into a "high-tech" birth. 

Its strong stuff and something I absolutely went along with when I was pregnant. After all, the NCT are the foremost childbirth charity in the UK. We paid a LOT of money to attend a course given by one of their most senior teachers, who told us that everything she said was evidence based. It turns out that that evidence never existed. 

I sincerely hope that the NCT will now update it's website and ensure that it's instructors are giving accurate, evidence based information to expectant parents. Of course there are plenty of people who've had a bad experience of induction and many who ended up with a C-section but the same is true of others who held out for a natural birth and plenty who went into labour at about the right time anyway. Childbirth is unpredictable with or without a medical kickstart.

Looking pretty rough after 34 hours of labour and an emergency C section - but hey at least I wasn't induced!

This is a good news story 

The result of all this is that women are now better able to make an informed decision, and I for one am all for that.  Of course there are still plenty of other reasons why an individual may or may not want to be induced (having been through much of the procedure I entirely sympathise with both sides). Ultimately it will always be a complex and individual decision and the last say must go to the mother. Always. But we can now remove from the decision the fear of that dreaded cascade into the operating theatre. It's simply a bunch of unpleasant anecdotes.

 This study also has implications for the recent advice that all low risk mums should be advised to give birth at home or in a midwife only unit. In these settings induction is unlikely to be available and this may actually increase the number of caesareans. As I've written before we need to ensure that all birth places provide a good level of care. Women shouldn't be scared to have an induction because it means they'll loose the better standard of care often available in midwife units or at home births.

The NCT and others in a similar position of authority now need to get this message out there. Much is made about the problems of fear in childbirth and here is one less thing to be afraid of so let's shout that from the hills. Or at least on the NCT website!

* For what it's worth I was so very desperate to get MissE out that I wasted a not inconsiderable sum on an acupuncture session in the hope of starting labour. I knew, really, that it wouldn't work but I wanted to do something, anything to avoid that induction. Oh and no, it didn't work and yes I am embarrassed I even tried.

Thursday, 17 July 2014

Pureed Evidence - Is Baby Led Weaning Scientifically Better Than Spoon Feeding?

It was puree all the way when I weaned MissE. I'd heard of Baby Led Weaning (BLW) , where babies are given whole foods and feed themselves, but I was terrified of her choking. To be honest, she was my first baby and I was terrifying of pretty much everything. By the time her sister came along, the twin gifts of experience and absolutely no time to over think, meant that I was somewhat more chilled out. I also had no idea how I would manage the infinite chore of peeling, steaming and blending with a marauding three year old in addition to the baby. So I decided to give BLW a go. MissM shared in whatever the rest of us were eating, it saved me a lot of time and worked well. Yes a lot of stuff ended up on the floor, but a fair bit made it into the baby too.

It is unclear if she was enjoying the broccoli, but she was clearly getting nutrition somewhere

Being me, I then decided to do a bit of research. I'd heard plenty of people claiming that BLW was just hippy dippy nonsense but many others were total devotees so I got hold of a copy of the most popular BLW book to find out more.

I was disappointed to find that, rather than offering practical tips for following BLW, much of the book was devoted to criticising puree feeding, and the criticism was pretty harsh. Get through all of it and spoon feeding could seem barely a step away from force feeding. Shovelling gunk into a poor, subjugated baby and setting them up for a lifetime of eating issues. The book is also very clear that there is no scientific evidence to support spoon feeding. That's probably a fair point, until BLW came along I doubt it occurred to anyone to prove that spoon feeding was the way to go - there was no alternative. But if the book can ridicule puree for a lack of evidence, there must be some pretty hefty science behind BLW? Right?

I turned to the reference section of the book to check it out, I'll be honest I was already feeling a little doubtful but I expected to find a few scientific papers, hopefully even a review that analysed a whole group of studies. I  really hadn't expected how many references there would be.


They are:

2 Dictionary's
4 Websites
1 Other book by the same author
1 Unpublished MSc thesis, by the same author
1 Scientific paper from 1928

For the whole 256 page book, which scorns spoon feeding for it's lack of evidence and suggests that mothers using the traditional technique could be harming their babies, there is only one proper, peer reviewed paper and in scientific terms it is ancient history. It may still have some valid information, but the way we eat now, the variety of food available and the ways we cook and store it, are all vastly different to what they were 86 years ago.

Spoon feeding; disappointingly not mess free

Now, before too many people start to get all defensive, I'm not saying there is anything wrong with BLW. I did it with my second child and would happily recommend it to friends who wanted to try. I just wish that the book had focused on the positives; How nice it is to eat with your baby and have both your hands for your own food, how much easier it is to only have one meal to prepare for the whole family and how much fun babies can have playing with new foods and lobbing them around the room. It could have given recipes and meal plans to help sleep deprived, befuddled parents. Instead it made a big deal about the lack of science behind the alternative and if you're going to do that,  you should have pretty damn good science for your own claims.

Dictionaries are not scientific evidence. Websites may be very informative or they may be complete nonsense. I could write here that:

I am a hummus expert - It has been scientifically proven that hummus is toxic and produced as part of a plot by our alien overlords to destroy the educated middle classes, so as to make it less likely that the clandestine alien takeover of the government will make it into a Guardian article.

Anyone else is now free to reference this blog as indisputable proof of the evils of chickpea based dips.

Referencing your own book and MSc isn't exactly convincing, I've not read them but I'm guessing the author is quite likely to agree with the author? I also have to wonder - if the MSc provides strong evidence that BLW is superior to puree, especially if it shows that puree is detrimental to health and development, then that is big news. So why wasn't it published? I've seen some pretty dreary, unimportant papers come out of MSc projects, this would certainly be worthy of a few pages in a major peer reviewed journal.

So where does this leave us? Is science behind baby led weaning or spoon feeding? Well, as far as I can tell, neither. There have now been a few studies comparing the two, and suggesting benefits for BLW but in every case it's quite possible that these benefits are down to other factors. BLW babies are, on average, far more likely to be exclusively breast fed for at least six months, to eat their meals with the rest of their family and to have parents who are well educated and fairly wealthy. All these things are likely to influence a child's subsequent diet and health. Most of the studies also rely on the parents opinion about their child's health and behaviour. So it's possible that the BLW devotees are expecting great benefits for their child so give more glowing responses than those spoon feeding parents who are less emotionally invested in their choice (for more detail on this see here).

So again, where does this leave us? It leaves us with two, perfectly valid, safe ways to wean our babies. Parents should be supported to do whatever works for them. In practise most people are probably doing a combination of the two anyway. But why must we have books that advocate one method by trashing the other? Mums can be pretty quick to judge each other, but we are lightning fast at feeling judged ourselves. Such a pile of negativity only feeds this. Surely what we really need is clear, non-judgemental advice about the best nutrition for our little ones? Not propaganda for the drawing of battle lines?


Thursday, 10 July 2014

London With A Four Year Old: The Natural History Museum And Beyond

For those who like them, sorry for the lack of science rants recently, if you're going to blog about people getting complicated stuff wrong you have to put in a lot of time making sure you aren't also talking out of your  own *ahem* and time has been in short supply of late.

Today's strike didn't really help with that, but rather than moaning about it I decided to make the best of my far too short notice surprise day of annual leave. Miss M was in nursery so I had a rare opportunity for a day out in our home city, with just my big girl and no school holiday crowds. 

For those with only tiny children - it is so liberating to have a day out with no buggy, changing bag or fixed meal and nap times. We headed off with just rain coats and an Oyster card (and Ana of course) and had a great day - here it is in photos.

Waiting for the train

Pulling faces in the train window

The Natural History Museum - amazing before you even get through the door.

Bring on the Dinos

Anamatronic T-Rex, I'll be honest, it was a little scary

Contemplating a blue whale tail

Lunch time treat in the museum restaurant

Watching the Guards at Buckingham Palace

After a long hunt we finally found one of the Pelicans in St James's Park

Then her buddies turned up too

Hourseguards Parade

Bloomin tourists

Finally worn out we "drive" the number 12 bus past Parliment, Big Ben and the London eye, all the way home.

Miss E was fast asleep by the time we past our old home 


Friday, 27 June 2014

5 Reasons Why Tech Firms Should Be Selling Wearables to Mums (Or should that be Moms?)

Not a Smart Watch

Google have just announced a range of new smart watches.  Devices, linked to your smartphone that sit on your wrist and let you know about incoming calls or messages and enable you to use apps and reject calls without even taking your phone out of your bag.

These newbies join some existing products with more thought to be on the way from Apple and microsoft in the near future. There's a lot of talk about "wearables" being the next big thing in consumer tech.

As a self declared gadget lover I'm kind of itching to get one of these things, but none of them has yet convinced me to stump up the (considerable) cost. The thing is, they are just all a bit big and blokey and I think the manufacturers are missing a trick here - where are the smart watches aimed at Mums?

Here are my top 5 reasons why someone should be making wearables for Mums:

1- We don't always have pockets

Most of these reasons really actually apply to all women, not just the mums. Blokes wear trousers all the time. Trousers have pockets. Women often don't have pockets or not ones that are big enough to hold a smart phone safely and without an unsightly bulge. So the phone goes in the bag and has to be dug out from amongst the nappies, spare clothes and unidentified sticky things, everytime it starts to buzz. It would be so much more convenient to leave the phone working away in your bag and peek at your messages on your wrist.

2- We need to know who's calling

There are times when your phone really needs to be on silent and it would be inappropriate to be seen fiddling with it. Unfortunately if you are a Mum there are pretty much no times when you don't want to be able to take that emergency call from school or nursery. A smart watch would be a great help here. No fumbling in your bag whispering apologies every five minutes, just glance at your wrist, realise it's another bloody sales call and send it off to voice mail with a flick of your finger.

3- We care about health

62% of those using fitness apps are women. The biggest group of these are aged 25-54. That's clearly going to include a heck of a lot of Mums. Most smart watches will integrate with fitness apps such as runkeeper or Samsung's own brand S-health system. Some also promise built in heart rate monitors, calorie trackers and sleep monitors that claim they could help you get a better nights rest - seriously - who'll want that more than Mums??

4- We're social

We blog, we tweet, we text etc. etc. etc. It's not unusual for me to be arranging a playdate while on my way to said playdate, pushing a buggy, dolling out snacks and trying to read texts and emails on my increasingly large smartphone. It would be so much easier if those texts just popped up on the buggy pushing arm!

5 -We like pretty things

We like them, we buy them and (lets be honest) we get other people to buy them for us. But the current offerings are going to look pretty big and clunky on a female wrist - come on designers let's have something for the geeky girls!

Some of the current offerings - picture from 

I've started a Pinterest board with pictures of current or coming soon smartwatches - you can take a look here Currently I'd say the best looking least ugly are the Moto watch but that's not actually out yet and the Samsung Gear fit, but that has limited functions and only works with Samsung phones.

Yes, after trying to avoid them for fear of the inevitable time eating that would occur - I've now succumbed and joined Pinterest and Instagram - you can click on those links there to follow me (although there isn't much up there just yet, I'm sure there will be soon!)

Wednesday, 18 June 2014

Some Poxy Questions - And Why Doesn't the UK Vaccinate Against Chicken Pox?

My kids recently had chicken pox, there seems to be a lot of it locally, so one of my mummy friends decided to get her daughter vaccinated. The response she got from some other parents shocked her:

"They looked at me like I had two heads!"

Most had no idea there was a vaccine and couldn't see why you would bother stumping up the cash to get it done anyway.

I meanwhile was getting similarly shocked responses from overseas friends:

"Are your kids not vaccinated? Why are they not vaccinated? That's nuts!"

(Gosh look, a parenting decision where, whatever you do, someone will judge you to be wrong, how very refreshing...ahem)

After much chatting in playgrounds social research, I've realised just how little many of us (me included) know about a disease that almost all of us have had and have nursed our children through. So I fired up the academic search engines (and what's left of my brain after a week on house arrest) to try to answer some FAPQs (that's Frequently Asked Poxy Questions) and to try to get my head around just why some countries vaccinate against chicken pox but we in the UK don't.

First, the practical stuff...

How long are kids infectious for?

They stop being infectious once all the spots have scabbed over. Unfortunately they start being infectious about two days before the spots even appear as the virus is lurking in the respiratory system at this point and can be spread by coughs and sneezes. Annoyingly the disease also has an incubation period of up to 21 days. So if one of your children develops symptoms, you won't know for weeks if their siblings are in the clear or if they are quietly  spreading the pox in that two day window.

Do I need to keep my kid away from Granny? I don't want to give her shingles.

You can't catch shingles from someone with chicken pox. Actually, Granny my be both the winner and the villain in this story...

**waves**read this bit - It'll be important later**

The varicella virus that causes both chicken pox and shingles is sneaky. Once you recover from chickenpox it's not destroyed.  Instead it slinks away and hides harmlessly in nerve cells for years, maybe forever. With your immune system now primed and on the lookout it's trapped there, but if that immunity is weakened,  usually by age, then the virus can re-emerge and it's this old, long forgotten virus that causes shingles.

Granny may even benefit from a visit from her spotty descendant. There is a theory (that's theory in the common usage sense science types) that being exposed to chicken pox might actually help prevent shingles.  It's like giving the immune system a booster shot so it can keep the old virus trapped.

Actually Granny might be to blame for the pox in the first place. You can't get shingles from someone with chicken pox but there is evidence of children catching the pox after getting the varicella virus from an  adult with shingles. Oh and there's more, but we'll come to that later....

Any tips for dealing with it?

Based solely on my very unscientific sample of n=2 here are my 4 top tips for dealing with chicken pox:

1- Poxclin- much easier to apply than the traditional calamine lotion, but much more expensive!

2-Oaty baths - oats in an old pop sock in the bath, meant to be soothing on itchy skin, not sure if there is any evidence of that but they thought having a bath in porridge was fantastically funny.

3-DVDs/Cbeebies/Netflix etc. If you can arrange a weeks worth of wholesome, educational, crafting activities at zero notice then well done you, you are a better woman than I. For the rest of us, best to just ignore that screen-time guilt for a while.

4-Remember it will all be over eventually...

It's basically harmless, right?

For the vast majority of cases yes. However the itching is pretty horrible and add in a small child with questionable personal hygiene and it's not surprising that skin infections are pretty common. Much more rarely infections can get inside the body and effect the brain or other organs. If you took 100,000 under 16's with Chicken pox somewhere between 12.9 and 28 of them would end up with a hospital stay (ref) (and no one wants 0.9 of their toddler in hospital!) Deaths can happen but are incredibly rare, in the UK it's about  0.04–0.05/100,000 per year (ref). It's also worth pointing out here that adults getting the disease for the first time are far more likely to suffer serious complications than children and also that complications don't just happen to those with other medical problems.

Where chicken pox might be a real worry is if a woman reaches childbearing age without ever having caught it. This is still pretty unusual, roughly 95% of people have had the pox by the time they are an adult but catching it for the first time during early pregnancy can badly effect the developing baby. Catching it right before the birth can be even worse. Newborns who's mothers had the pox in childhood will get some temporary antibodies against the virus from her. But if Mum gets it right before the birth there isn't time to make those antibodies and the newborn is completely unprotected. This is a pretty horrible thought, but left untreated, the death rate could be up to 30% (ref)

Can Chicken Pox be prevented?

Two doses of the vaccine will give total immunity to about 95% of kids. If 90% of kids were vaccinated the disease wouldn't be able to spread so everyone would be protected. But the vaccine is only available on the NHS to specific, high risk individuals. You can get it privately but it is very expensive. In London you are looking at about £65 per dose plus a £45 appointment fee. (Compare this to the $24 that a friend paid at a very fancy clinic in NYC).

But don't you get better immunity from actually having chicken pox rather than having the vaccine?

I couldn't find any evidence at all of this. Long term the Jab actually seems to be a much better bet as it also significantly decreases the chance of getting shingles. (ref)

OK, so how come some countries vaccinate against this but in the UK  we don't?

**Waves**This is where that earlier bit is important**

There are a few potential downsides to vaccinating all children against chicken pox. The official reason here seems to be the worry about shingles. The concern is, that if we get rid of chicken pox then older people will no longer get their "booster" and there will be more cases of shingles, a potentially more serious condition and one that costs the NHS more than chicken pox. You remember I said there was more on the Granny front? Yep, saving Granny from shingles is apparently why we're not sparing kids from chicken pox.

There are other worries too. It's unlikely that absolutely everyone would have the vaccine, maybe less than the magical 90% would. In which case the disease would become rare but wouldn't disappear and that unvaccinated minority may escape the disease in childhood only to get it, far worse, as an adult.

The thing is though, there doesn't seem to be much evidence for either of these ideas.

Universal chicken pox vaccination has been going on in the US since 1995 and levels of the disease have plummeted. Other countries have followed suit so surely those countries should be seeing lots of cases of shingles and adult chicken pox?

A recent review looked at studies into this from the US and a few other parts of the world. It found that since the introduction of the vaccine for toddlers, cases of chicken pox have dropped in every age group. Meaning that even those who aren't vaccinated are benefiting overall. On a personal note I think it's a pretty naff excuse anyway, if the vaccine were free on the NHS then anyone denied it by their parents as a child could choose to have it as a young adult.

The review also looked at shingles cases. It did find an increase over time - but in the period before vaccination was introduced and ongoing in countries where it isn't given. Overall some individual studies found a  rise after vaccination, some didn't and it's impossible to tell if vaccination has made any difference at all to the general upwards trend. Some people have predicted that there will be a decrease in coming years as those who were protected by vaccination enter the at risk age groups (ref).

Then there are the other reasons.

The Media and the Money

Sadly, following the whole MMR press-frenzy-debacle, there is still a lot of lingering public concern about the safety of vaccinations and one of the common ways of giving the varicella vaccine is in combination with the MMR as a single MMRV jab. There is already a (completely incorrect but understandable) fear that the body can't cope with lots of vaccines all in one go so there is a worry that MMR+V= tipping some people over the edge into not vaccinating against anything. We've seen the return of measles to some areas of the UK, more of that is a scary prospect.

Finally of course, in the "cash-strapped NHS" there is the economic argument. Kids getting chicken pox costs the NHS very little. Most won't even go to the GP, very few need money spending on them in hospital. The major costs are to families and businesses when parents need to take time of work. the long incubation means siblings probably won't all get it at the same time so a family with multiple kids could be at home for weeks. No doubt that has an economic effect, but not one felt by the NHS, so I can understand why they are unwilling to be the ones forking out to vaccinate everyone. The review mentioned above also looked at the economics of the vaccine and couldn't come to any conclusion as to weather vaccination saved a country money overall or not. 

So should we be vaccinating here? 

If money were no object I'd say yes, absolutely. I've said this before but I thought it was a good point so I'll make it again:

Stuff the moon landings, global vaccination programmes are man's greatest achievement.

 The medical arguments against it are unconvincing and confusing. If its really all down to economics let's just be honest about that and say the money is needed for nurses and cancer drugs. I would like us to vaccinate in the UK but I'd like the NHS to have more money for lots of things and realistically I know the pot isn't big enough for all of them.

It should at least be more widely publicised and more readily available so parents have the choice. Perhaps as an at cost option at GP surgeries, in the way some travel vaccinations are. I begrudge paying a massively inflated cost to a private clinic, especially as many of those clinics also profit from implying there is still uncertainty about the MMR (there isn't) and then flogging the single vaccine alternatives to those they have just terrified.  

If you could go back in time, knowing what you do now - would you vaccinate MissE and MissM?

Yes. The only reason I didn't before was the cost. The cheapest option I could find for both of them was over £300. Ouch! But add up the missed days of  work and already paid for nursery and afterschool club, plus the last minute train ticket for Granny to come up from Devon to help out (Grannies aren't all bad after all), the wasted festival ticket and the pots of poxclin and calpol- we'll I've not done the maths but £300 can't be far off. 

So there it is, stuff I know now that I didn't before. Strange to think how little most of us know about something so common. Does anyone else have some interesting Poxy facts that I've missed or more tips on dealing with it? If so please add them in the comments.

 Neither of my girls was particularly unwell, just very spotty but each had a heartbreaking day of feeling utterly miserable. Like any Mum, I wish I could have taken that away but at least we are done with it now and I've had a really fascinating time finding out more about that sneaky little virus.

Sometimes you just need TV and a really big Teddy

PS.  As a reminder- I'm not a medical doctor, all the above is my interpretation of the best evidence I could find but if you need advice talk to your GP. Never depend on random blogs for medical facts, even my random blog.

Wednesday, 28 May 2014

Blog awards, The Pox and Camping Solo with a Four Year Old

To summarise,  last weekend basically went like this: bad thing, bad thing, Brilliant, lovely awesome thing.
Now in slightly more detail:

Blog Awards:
On Friday the finalists for the Brilliance in Blogging awards were announced and sadly I didn't make the cut. Even so I'd like to say a huge thank you again to everyone who took the time to vote for me. I often suspect that this blog doesn't fit well in the parent blogging world. Advocating proper scientific evidence over anecdotes, beliefs and what seems "natural" isn't generally all that popular and, compared to personal stories, it's hard to turn a bunch of dry statistics into a compelling read. So, although I'm calling Friday's announcement a bad thing,  I'm still utterly delighted and shocked just to have made it to the shortlist. Yay!

The Pox
MissE had chicken pox 10 days ago (non-UK readers, the vaccine isn't routinely given here), and so with grim inevitability MissM developed the dreaded spots on Friday evening. This one is definitely a bad thing as we were all supposed to be going camping for the weekend. So what to do? All stay home and disappoint MissE? One of us stay home with MissM and the other go solo camping, to a festival, with a four year old? After tears from MissE and considerable indecision from me, F made the decision: I'd been on house arrest while MissE was ill, so I got to go camping and he would stay home with the poxy toddler (besides I'm better at putting the tent up than he is).

Which brings me to...

Solo Camping With A Four Year Old
My husband is very good at carrying stuff and telling me when I'm being irrational, he also produces a considerable amount of body heat and has a good sense of direction. These aren't his only qualities by the way, but they are particularly useful  when trying to go camping in a mystery destination with small children. I'll be honest, the thought of doing it all without him was pretty daunting, all the more so when I woke up to pouring rain, but I didn't want to let MissE down so I put on my best independent woman face, checked the directions 15 times and set off.

I'd gone the wrong way by the time I'd left our street. *face palm*

But all hail the sat nav (and the Lion King DVD that kept MissE happy), we were soon sailing through the traffic free streets of early Saturday morning London (love that), bombing along the motorway and then gingerly up the dirt track to the secluded Feast In the Woods site.

I'd been worried that this would be a bit stressful on my own, it actually turned out to be one of the most relaxing weekends I've had in ages. We parked up and then walked through the woods to a little clearing with a fire pit already on the go. MissE was directed to a little bridge, leading to a wardrobe in the woods. Stepping through the wardrobe she found a kids entertainment team with face paints and crafts all ready to keep her happy while I got on with pitching the tent (with a bit of help from some kind folks around the campfire). Before long MissE had found some new friends and bonded over a mutual love of Disney's Frozen. The little Elsa's and Ana's ran wild for two days, dangling from swings in the trees and toasting marshmallows on the fire but the thing that really amazed me was that the only screaming strop MissE had was when I wouldn't let her fling her (non-swimmer) self into a lake. 

MissE has never liked water. I sometimes joke that my natural birth plan only failed due to her horror at the birthing pool. While other babies love splashing in the bath, she wailed in terror at it for her first year and the baby swimming classes I'd so looked forward to were a total, expensive, write-off. Recently though, she has been having swimming lessons with a lovely teacher and after a day of rare physical bravery and having seen so many other kids in the water she actually begged me to let her go in too. So I donned my swimmers, took a deep breath and jumped.  After about two minutes of gasping for breath in the cold I pushed an inflatable crocodile over the MissE on the jetty and we splodged about in the water until I got cold again and had to beg her to get out. It beats the heck out of a festival shower queue for feeling refreshed though!

There was also great food, lovely cider, the endlessly amusing composting loos, pond dipping, ukuleles and at least an hour where I just sat in the sun reading a book while my daughter roamed free in the woods with her friends. Bliss.

By the time we got home I was filthy and exhausted, by the next day every inch of me ached from packing everything up on my own (then unpacking and re-packing it all because I thought I'd lost my glasses) but it was totally worth it, MissE and I both had a wonderful time and I actually feel pretty proud of myself for taking on something I was a bit nervous of. We've already booked for next year, hopefully we will all make it this time but if not, I'll have no worries about going solo again.


 PS. My photos don't really do the weekend justice but much more lovely ones can be found here:

Wednesday, 14 May 2014

A Few More Notes On the Nice Guidance

When I wrote about the new NICE guidelines yesterday I hadn't been able to find the actual document and was relying on the news stories about it (none of them seemed to link to the source, helpful!). Inevitably about 25 seconds after I hit the publish button I found the document. Cue hurried skim reading and even more hurried re-write.

I've now had chance to read at least a couple of the relevant sections and some of the many other blogs that have been written on the subject and I thought it was worth adding a few notes.

Firstly, for the most part I agree with the new guidance. It says:

Explain to the woman that she may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support her in her choice of setting wherever she chooses to give birth

But it goes on to say:

Advise low-risk multiparous women to plan to give birth at home or in a midwifery-led unit 

Advise low-risk nulliparous women to plan to give birth in a midwifery-led unit

(nulliparous women are those who haven't given birth before, multiparous have)

And it was that word - "advise" that concerned me. 

Low risk women should be advised that a midwife led unit is just as safe as an obstetric ward. It should be explained that these units have lower rates of interventions, and of the potential risks of these interventions. If that's done many more women will probably choose this option and I'd welcome that. 

But I don't think they should be "advised" that this is what they should plan. You're not giving someone a choice, if you then tell them what their choice should be.

For all their benefits there are a couple of down sides to the NICE approved options. Firstly, the transfer rate, especially for first timers is high. Women need to be aware of this and prepared for the very real possibility of a fraught ambulance trip if they aren't in hospital. Would that be better or worse for them than having medical intervention hovering in the background all along? It won't be the same answer for everyone.

The other snag is pain relief. If you really want the pain to go away an epidural is your best bet. It's very safe and I for one see nothing morally wrong with choosing to avoid the pain of birth. The guidance says:

If a woman in labour asks for regional analgesia, comply with her request. 

It also adds that women must be cautioned about the risks and benefits and, importantly that you can't have an epidural at home or in a midwife unit.

So effectively the new guidance is advising women to give birth in a setting where serious pain relief is not available to them. It's saying you have a choice, you can have this nice place where you won't have nasty things done to you but, if you want pain relief, you will have to give all that up and argue against your doctor or midwife's advice.

It also sends a very strong message that epidurals are somehow a wrong choice or at least unnecessary if you do this birth thing properly. 

Then there is the risk that we create a two tier system for birth. 

Already women choosing a home birth are likely to have better continuity of care throughout pregnancy, birth and the postnatal period. Rather than sharing one stressed out midwife with other women on the labour ward, a home birth Mum will have two who she may know already, all to herself. At the hospital where Miss E was born the facilities and environment of the midwife unit were sufficiently enticing to encourage women to choose it over the obstetric ward, even without information on interventions. Women should be able to choose between epidural or no epidural, not between pain relief or decent care.

What also seems to have been forgotten in all these debates is that not all women are low risk. Actually an awful lot aren't (and sometimes the judgement over who is and who isn't can be wrong, which is another issue). All these other women seem to have been swept aside in this debate, are we only interested in those who through dumb luck are able to have a choice? If we demonise obstetric units how will that make women feel when they are told that, for them, the people most in need of care and support, the "wrong" choice is their only choice?

Let's have midwife units available to everyone, ideally (in my opinion) on a hospital site so the transfers aren't too traumatic. Let's offer home births where it is appropriate and lets continue to make those environments as welcoming and stress free as possible. But let's do the same for obstetric units too and let's be careful not to place a moral judgement on pain relief.  Then we can advise women of the theoretical best option but not dictate a one size fits all "correct" choice.

For what it's worth I thought it may be helpful to explain my own experiences. Inevitably they influence my opinions. I was low risk for my first pregnancy, I chose to give birth in a midwife unit in a hospital. I was hoping for a natural birth, maybe water, I wasn't keen on epidurals and was confident in my ability to cope with pain and exhaustion but I also liked having the obstetric unit down the corridor just in case. I never expected to use it. At that point I thought that if all went well I might have a home birth for any subsequent babies. Basically my choices were exactly what the guidelines would recommend.

In the event things weren't straight forward and I had to transfer. When it became clear I was in for a long haul I had an epidural for a while. I let it wear off to push the baby out but unfortunately that didn't work out either and I had an emergency C-section. For my second child I wasn't low risk and I opted to have a planned C-section.

If I were doing it again, I would still opt for the midwife unit, I'd still want to avoid an epidural but I would perhaps try to be a bit more prepared for things not going to plan!