Friday, 5 June 2015

Should You Eat Your Placenta?

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

Things have changed a lot since 1998.

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

But do those claims stack up?

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

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

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

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

Incredible claims

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

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

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

What's the harm though?

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

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

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

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

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

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

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

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


Family Festivals 2015 - Feast In The Woods

or, Mum Unplugged.

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

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

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

I think she was a tiger at some point

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

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

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

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

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

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

Bamboo Trumpet

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

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

This is how to deflate an airbed


Wednesday, 27 May 2015

Are Women Losing The Ability To Give Birth Naturally?

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

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

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

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

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

nah, not so much.

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

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

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

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

And then we get to the real woo.

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

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

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

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

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


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

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

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

Friday, 15 May 2015

The Measles Vaccine - With Extra Life Saving Bonus

Or - why science is amazing and wonderful and cool.

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

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

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

The Bad News:

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

The Good News:

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

Errr - how is this good news?

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

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

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

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

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

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


Saturday, 9 May 2015


Imagine you are taking part in some sort of extreme sport endurance event, say a really long, non stop hike. You're not at peak fitness but, at the start, it's going ok. However, 20 or 30 hours in it's got a lot harder, you're climbing up ever steeper hills, tired and in a lot of pain. It's as much a psychological battle as a physical one, you want to give up but you force yourself on, up the next hill and the next, you can't even see the finish line yet. Then suddenly something happens. Maybe an accident or an injury. The event you expected to be tough but safe has suddenly become life threatening. There are people everywhere and you're rushed to an operating theater for major surgery. You are exhausted and terrified but thankfully you pull through.

Now what you might think you'd need after all that is rest and sleep so you can start to recover. But weirdly you find yourself in some strange world where, not only is it assumed that you'll stay awake, possibly for several more days, but you're also expected to think it's all been the most wonderful experience of your life. Oh yeah and did I mention you'll also be handed the biggest responsibility of your life at the same time too?

(Have I stretched the metaphor too far yet??)

Seems ridiculous right? Of Course people would realise you need to sleep after all that. But swap the endurance hike for a long labour and make the surgery an emergency c section and it's a pretty ordinary experience of an NHS postnatal ward.

The absurdity of that struck me somewhere into my second sleepless night on one such ward. The doctors and midwives were telling me I needed to be in hospital to recover but all I really needed was someone to keep an eye on me, regular pain medication and some rest. I was getting none of those things on that ward (you can read more about my postnatal care here, it's not a happy story) The complete lack of sleep was unbearable. I finally left the hospital on a Thursday afternoon, the last time I'd gone to sleep was the previous Saturday.

Of course we expect new mums to be sleep deprived, it's kind of a grim joke and oh how everyone loves to tell you all about it when you're pregnant. But does that mean that mums don't really need rest to physically recover from a c section or a difficult birth or even a pretty straight forward one? Does one source of sleep deprivation mean you should just accept all others? Noise? Pain? Fear? Suck it up ladies you're a mother now. Major physical trauma is no reason to sleep on the job!

It's also possible that sleep has a roll in psychological recovery. Many women who have had difficult births walk away with just some bad memories or a good horror story, others suffer lasting psychological trauma. There is likely to be a large number of factors involved in determining who develops trauma symptoms but I wonder if sleep, or the lack of it may contribute. Heads up I really am speculating here which isn't very scientific I know, but there simply isn't much research on this at all. We do know that sleep problems are a symptom of trauma and PTSD and there is some (very limited) evidence that sleep disturbance prior to a traumatic event increases the likelihood of PTSD but I wonder what effect extreme sleep deprivation after giving birth might have?

I started thinking about this a few years ago following a conversation with a clinical psychologist. After my daughter was born I found myself telling the story of her birth over and over again in my head. I didn't want to, but it was always there, nagging at me. The Psychologist explained that sometimes difficult memories get stuck, the brain fails to file them away as it should and they remain rumbling around where they aren't wanted. We do know that sleep is important for consolidating learning and memory, could it be that sleep deprivation after a traumatic event interupts that filing process and increases the risk of problems later on? As I said that is pure speculation I couldn't find any studies on it other than one in mice which actually suggested the opposite. I'd love to see more research in this area.

So, if we accept that new Mums need to be able to sleep, for physical healing, maybe pschological healing and just because oh god how we need sleep - what can be done to make it possible? It's tricky, but I don't think you should criticise something without offering alternatives so here are a few ideas:

The dream scenario: (no pun intended)

Single rooms, space for partners, noise limiting design, lots of time with kind and reassuring staff. This would all be great, but of course it costs money!

The easier stuff:

Respect - staff, mums and visitors should be encouraged to keep noise to a minimum at night. That's surely just common courtesy but it often doesn't happen.

Babies of course can't be expected not to make noise and if there are four or more in a room that could be a lot of noise. So perhaps if there isn't space for single rooms a few quiet spaces could be set up where mums could go to get away from the noise of others for a while, even if only to rest rather than actually sleep. It would be a whole lot better than the night I spent on a plastic chair in a milk pumping room! Or maybe there could be a nursery, not the strictly enforced separation of mum and baby that used to happen, but an option to have your baby cared for by someone else just for a short period of time.

Out of Hospital Care.

Maybe we should also be looking at caring for women away from hospitals all together? Like The Duchess of Cambridge, many women who have straightforward births now go home within hours, but could more complicated cases also be cared for at home? If there was better and more consistent out of hospital post natal care then many more women could probably go home sooner. Even after my emergency C section all I really needed was pain relief, occasional basic checks and some help with breast feeding. All that could have been done at home, in my own bed, with my own food and no noisy strangers. I was only minutes from the hospital if there was a problem. This level of home care is already available to a lucky few who have NHS caseload midwives. It would be great if it could be extended to everyone who wants it.

Ultimately being a new Mum is bound to be exhausting but the noisy and chaotic environment of post natal wards and the resultant lack of sleep is something many women struggle with. I've heard several Mums say that their experience on the ward was far worse than the birth itself. Surely it's worth taking a few simple measures to promote rest and recovery? Is it really indulgent or ridiculous?

This post goes along with the end of the #MatExp ABC on twitter. There has been a lot of talk about creating  safe, comforting and calm environments for women to give birth in. The Maternity experience is, for most, just the start of a lifetime of joy, and hard, hard work, I think we should extend that nurturing and care for just a little longer, so that mothers can head out into their new life ready for all the trials, and all the wonder, to come.

Home, asleep


Monday, 27 April 2015

Normal Not Normal

A #MatExp post

N is for Normal

Today we reached N in the #MatExp ABC and that brings me to "Normal" birth. Regular readers of this blog will have noted that I tend to put normal in " " and may also have guessed that that is because I'm not very keen on the the phrase.

One of the things often discussed using the #MatExp hashtag on twitter is the power of the language used when talking about birth. For example, I know that a lot of Mums and some medical professionals dislike the term "failure to progress". It's a technical term and intends no judgement on the mother's efforts, but the word failure is of course very emotive. That one didn't personally bother me, perhaps because I work in medical research and am used to there being lots of words and phrases that mean one thing to those in the field and something different to everyone else. But I appreciate that language is important and one phrase that I find really problematic is "normal birth".

For those who aren't familiar with the term, a "normal" birth as defined in the Birth Place study is a birth without induction, forceps, ventouse, caesarean, episiotomy or epidural, spinal or general anaesthetic  I have a number of issues with that:

1- Conforming to a standard; usualtypical, or expected:
1.1 - (Of a person) free from physical or mental disorders:

If This Is Normal - What Is Abnormal?

The main problem is, if you declare that a birth is only normal if it meets a strict and specific set of criteria then, by default, any birth that falls outside those criteria is not normal, it is therefore abnormal. Clearly forceps and epidurals etc are not natural parts of birth but are they really abnormal?  I find this hardest to reconcile where pain relief is concerned. As I've said many times on this blog, I see nothing inherently wrong with making an informed decision to want pharmacological pain relief in labour. For many women, giving birth is extremely painful and I struggle to understand how wanting pain relief for something very painful is an abnormal action.

Nudging Normal

Normal also implies that this is how the majority of births happen, i.e. how the majority of women give birth. Telling people that "that's what everyone else does" is a powerful way to influence their decisions and one that is utalised by advertisers and government agencies. For example, it may be more effective to tell people that most others in their area have already done their tax returns, than to just threaten individuals with fines if they don't. Suggesting to women that most other mothers, normal mothers, have unmedicated vaginal births applies subtle pressure on them to conform to this ideal.

Is "Normal" actually Normal?

I'm not even sure if most women are having "normal" births.  If anyone has better stats on this please let me know but going on the Birth Place Study data it seems like "normal" births aren't the clear majority. It found that for every 1000 low risk births in hospital, only 460 will be classed as normal. The majority of those planning homebirths do achieve the "normal" classification but that is still relatively few women so may not do much to alter the national average and, significantly, this data excludes all high risk births, which are presumably more likely to involve drugs or interventions. Essentially as far as I can tell, "normal" birth, isn't actually the norm.

***Update - many thanks to BirthChoiceUK who have confirmed that for England only around 40% of births meet the Birth Place Study definition of normal.***

What Is Normal Anyway?

Finally, I wonder about the criteria for normal. I can appreciate that syntocinon drips, instrumental deliveries and emergency caesareans should only happen in the event of medical need, ie. when something unexpected / not normal has happened. But then I come back to the pain relief issue. Why is it abnormal to have have a well researched and highly effective form of pain relief with known, minimal side effects (an epidural) but it's entirely "normal" to strap a small electronic device to your back and get it to give you regular electric shocks, even though there is little evidence that it's actually effective (a TENS machine)? Similarly if a "normal" birth is one that avoids any modern interventions why is it "normal" to labour and/or give birth in a recently invented, specialised pool of warm water? I'm not saying there is anything wrong with waterbirth by the way, I spent hours in the pool during my first labour and found it very helpful and calming, but clearly for most of human history women didn't have access to large quantities of clean warm water. Finally (actually I'm sure there are more but I think you get my drift) why is it abnormal for a birth to involve surgical incisions in the abdomen but a vaginal birth that results in the mother needing stitches, or even surgery under general anesthetic is still "normal"?

Of course sitting here and criticising from the comfort of my own blog is easy enough, I have no better word than "normal" for the type of birth described. I slightly prefer "natural" as normal birth is essentialy that - a birth which needs no help from modern medicine, and personally I would rather be unnatural than abnormal. But I appreciate that natural comes with it's own problematic connotations.

But do we even need a word to classify this? Doing so, and placing the emphasis on getting more women to have this particular kind of birth worries me. What about those who can't meet this standard due to medical reasons? What about those who can't or don't want to endure the pain? It seems to me worryingly patriarchal to hold up one kind of birth as the ideal for all women at a time in our history when there have never been so many good, safe, options available. I am all for supporting women who want this kind of birth but I worry about just where support and encouragement turn into persuasion and coercion.

For me, "normal" is a mother who wants to ensure the well being of her baby and who will make huge personal sacrifices to achieve that. Whether that means enduring the pain of a natural birth, the risks and indignities of interventions or the arduous recovery from a C section. There are so many different kinds of birth, none is inherently better or more valuable than the others, and none can claim the title "normal" by shear weight of numbers. The only thing that is genuinely Normal about birth is the everyday, ordinary heroism of mothers everywhere, bringing their babies into the world the best way they can.

Tuesday, 21 April 2015

H is for Hospital, Home and Genuine Choice

This is another #MatExp ABC post. Today we have reached H and when I went on twitter this morning the first suggestion I saw was H is for Homebirth. That got me thinking and, as usual, 140 characters wasn't really enough. So my H is for Hospital birth, Home birth and genuine choice.

To be clear I am not at all against home birth. I support the idea of making it available to more women and of giving them accurate information about how safe and beneficial it can be. But, especially online and in social media, I hear a great many voices, mothers, midwives, doula's etc. all championing that cause. I stand with them, but I also have some concerns.

I'll be honest, when I read stories of high risk mothers having home births it does worry me, ultimately I support the ideal that it's her body her choice, but as a mum who saw her straightforward natural birth become anything but, I can't help but worry about what might happen. That however isn't what troubles me most about the current advocacy for homebirth. I have two main concerns:

1-Avoiding the problems

The birthplace study led to many calls for all low risk women to be encouraged to give birth at home. It found that those who did were less likely to end up with interventions such as c sections and and epidurals. But what few commentators seemed to ask was - why are there so many more interventions in hospital and if they are unnecessary - how can we stop them? The consensus seemed to be that it was better just to convince women to have home births so they could avoid the problem. But where does that leave those who want to be in hospital? A lot of mums actively choose to have an epidural and you can't get that at home. What about the mums who would have loved a straightforward home birth but who's pregnancies have become too complex for them to feel safe at home? What about those whose home environment isn't safe and comforting?

1- Equality of care

My NCT teacher was a staunch advocate of homebirth. At our first class she advised us all to have one or to at least pretend we wanted one (then fake chickening out at the last minute). It might seem a bit bizarre to pretend to want a homebirth if you don't, but (on this at least), she had a point. In our area, planning a homebirth means you have a named midwife working with a small caseload team. That small team will all get to know you and care for you before, during and after the birth. Each midwife has a carefully limited number of women to ensure she has enough time for all of them. In a cash strapped NHS it's an amazing service. But it's only available to those choosing a homebirth.

I worry that these two aspects could combine to create a two tier maternity service within the NHS. Excellent, consistent care, a nice environment, time to discuss options and fears, no unnecessary interventions - but only if you are willing and able to have a homebirth.

Clearly the losers here are those many women who need to be in hospital. Who, in many cases will be those most in need of kind and consistent care. It effectively says you can either have modern medicine or compassion, but not both. Fall from that narrow pedestal of "low risk" and you may have to accept that the demon doctors will be waiting for you.

That said, I don't think this dichotomy is good for anyone. I am all for women making informed choices about where and how they give birth, but that choice should be between giving birth at home, in their own, familiar environment or giving birth in a modern hospital with every possible form of medical assistance and pain relief close at hand. If we simply wash our hands of the problems in hospitals and instead tell people to go home to avoid them, then that is not the choice that's being made. Instead we are asking women who think they will want an epidural to chose between between good care or pain relief. It means women who develop complications in pregnancy will have to decide between compassion or safety. That's not making the best choice for yourself, it's going with the least worst option.

Women should be able to chose hospital birth because it's what they want, not because they have over inflated fears of homebirth. But they should also be able to chose homebirth because it's what they want, not because the alternative is terrifying and those whose choices are limited by their medical or social situation should never be forced to accept sub standard care because no one was shouting loudly enough for them.