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Big Mother - How Obesity REALLY affects birth. |
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Having watched and listened to women attending antenatal classes for over fifteen years now, I've noticed for a long time the correlation between obesity and difficult labours. Yet I've long wondered about the similarity to the "older" mother : the obese woman can be so surrounded with doubt as to her ability to give birth that it becomes a self fulfilling prophecy of doom. Added to this, obese women can be made to feel so completely ill at ease with their own bodies that they are inhibited about displaying their bodies, feel exposed to comment and censure from their carers and are unlikely to strip naked, exude oxytocin and birth in amazonian triumph. One of the saddest moments in my antenatal teaching career was listening to a plump, but not clinically obese, woman telling me her birth story. She had been labouring well at home and then went to hospital as planned. She had hoped for a water birth and, as she was already 6cm at admission, was soon stepping into the lovely pool at her local unit. As she did so, her midwife asked her whether she'd been drinking a lot of milk during this pregnancy. She felt this was an overt comment on her size and guess what happened to her labour? She never dilated another millimetre and the birth ended up in failure to progress caesarean, postnatal depression and misery. I do wish I could have persuaded this lady to complain. But she had perfectly absorbed the "failure to progress" as her own body's failure, the label on her size, accepted as just her dues for committing the social sin of being mildly overweight. Just this week there has been research showing that fertility can be impaired in eating disordered women and it has long been recognised that for an anorexic, pregnancy is a desperately difficult time. Also that pregnancy can be the trigger for eating disorders or can make an existing disorder worse. Being "allowed" to gain weight, have a tummy - the removal of the societal pressure to be a sexually attractive "babe" can remove some self imposed restrictions on eating. For others the terror of being out of control, feeling compelled to "eat for two" can have disastrous effects on existing coping methods. If the woman you are seeing is already obese she may have a compulsive eating disorder of which she is already bitterly ashamed. It may already be a huge ordeal to present her bump for palpation, muttering about how you can't feel the head through the layers of fat will send her home to raid her cupboard and stuff back down all those feelings the whole appointment has aroused in her. In short she is in need of just as much sensitive care as the anorexic, she is however exceedingly unlikely to receive it. Obesity is the new smoking and it is often viewed in a worse light. At least smokers are acknowledged to have an addiction, if you are overweight you are merely sinful, indolent, greedy. It is still perfectly socially acceptable to make fat jokes with impunity whereas most comedians nowadays hesitate before making pejorative comments about someone's sex, race, sexuality, mental capacity or colour. In my more "to terms" moments I can call myself Reubanesque, voluptuous or traditionally built. Yet every morning I listen to the Radio One DJ Chris Moyles, no skinny minny himself, refer to fat women as "lard-arsed". Before even considering being upright and forward leaning to birth my babies, my first thought would be who would be looking at my bottom while I did so and what comments they would be making to themselves. Midwifery is still, in the main, a female profession and many midwives will themselves be overweight yet many will not themselves be at ease with their own size and may have many personal conflicting feelings about approaching the subject with a woman for whom they are caring. Advising a woman not to put on too much weight when you are traditionally built yourself can lead to some interesting conversations. And women don't take kindly to being lectured by those who clearly do not have a weight problem themselves. So for the midwife who is overweight herself she may feel she does not have the authority, if she is not overweight she may be perceived as judgmental. Actually the perception of being judged by a younger, skinnier midwife isn't misplaced -I've just had the misfortune to read the Community Midwife's comment on her Facebook page about a client with a "mahoosive apron and gigantic BMI" and how disgusting it felt to palpate her sweaty abdomen. Gee, thanks for that, I'd feel really inspired to attend my midwifery appointments if I were pregnant now. The protocol may suggest referral to a nutritionist but I've yet to find any evidence that this achieves positive results. The popular perception of a nutritionist is being lectured and given a diet sheet. Many obese women have already failed at every diet imaginable and find it laughable that health professionals believe that women simply don't know what to eat. Most overweight serial dieters can tell you the calories, weight watchers points and sin values of every food in your average supermarket. What they can't tell you is why they are still overweight. This is where having time to talk in a non pressured, non judmental environment might achieve dividends for maternal and infant health. Yet how can this be achieved in a system which allots fifteen mintutes per woman in a busy antenatal clinic? It is possible to support smokers to give up smoking without impairing their view of their own body and the effect on the pregnancy is immediate. Yet an obese woman still has to eat and by the very act of telling her what impact obesity can have on pregnancy, birth and breastfeeding, are health professionals actually setting her up for failure? Trial by BMI is, in any case, a very crude and ineffectual method for decisions on place and mode of birth. Caesarean is a much riskier mode of birth for an obese woman with increased risk of postpartum morbidity and death. Yet by routinely refusing women access to midwifery led units and birth pools are their carers not putting them on that very path to surgery? Is this not iatrogenesis in action? As always what the system needs and what the woman needs might differ. As an autonomous practitioner ,a midwife might feel that a particular mother to be is intrinsically well, is motivated to manage her weight, has stable blood pressure and no signs of diabetes. What the protocol will say is refer to consultant, decline admission to stand alone maternity unit and strongly dissuade from a home water birth. As well as telling her what her weight might do to her pregnancy and birth will anyone also honestly tell her what attitudes she is likely to encounter and how that might further impact her self esteem? Will she be told that she is likely to end up flat on her back with a belt monitor and an epidural heading fast down the route marked "emergency caesarean"? Or will your average midwife continue to intone "Well I'm afraid your BMI means that you have to be seen by a consultant" and usher her off before she sneaks a quick bag of maltesers and breathes a sigh of thanks that she had her babies before she got to that size?
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Last Updated ( Friday, 05 August 2011 )
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Boob Bashing Hits Fleet Street Again |
Well here we go again, the annual Have a Pop at Breastfeeding Week
begins again next week but the Daily Mail has got in there extra early
with a corker of an article slating the Breastfeeding Gestapo - a new
angle on the Nipple Nazi tag of yesteryear. In any other profession but
journalism you would be honour bound to at least debrief your own
previous experience so that it didn't impair your professional
judgement but Fleet Street seems to attract women with such bitter
personal experiences of birth and breastfeeding that they are no longer
able to differentiate between fact and their own painful memories.
Worse, having been let down so horrendously by the medical profession
they turn their anger on the charities and volunteers who support women
to breastfeed.
I'm tempted begin each breastfeeding class now
with "My name is Jenny and I am not a nipple nazi! I promise to
continue to show you non judgmental, empathetic support with
unconditional positive regard as demanded by the body which has
provided me with more training than most midwives, health visitors or
doctor you will meet in your parenting career. I will continue to give
up my unpaid family time through evenings, weekends and bank holidays
when every health professional has shut their surgery to offer you an
opportunity to talk to someone who will listen without giving advice
and to suggest practical ways to enable you to breasteed if that is
what you want to do.
I am not and have never been in the
business of telling people how they should parent their children. I
have never felt compelled to strut about clicking my heels and ordering
women to breastfeed nor have I ever tried to make mothers feel guilty
for not breastfeeding. I don't actually believe women who formula feed
should EVER feel guilty about not breastfeeding because all too often
they have been given woefully inadequate support and information by
their health service and have been brought up in a culture that neither
values nor supports breastfeeding. Worse still, should they succeed,
against the odds, in breastfeeding and wish to go on to support other
women they get labelled in national newspapers as The Breastfeeding
Gestapo or Nipple Nazis or Lactivists (actually I quite like that one).
I am not however going to lie to you and say that breastfeeding doesn't matter.
It
does and there is extensive research to prove that not breastfeeding
makes a big difference to mother and baby health but because we are so
terrified of 'hurting mothers feelings' and 'making women feel guilty'
we misrepresent this routinely as The Benefits of Breastfeeding. So
most women think they are being nagged at and pushed to do something
that feels alien, that their mother probably didn't do and which
doesn't feel normal, never mind natural and whose value they do not
clearly understand.
I do know what it feels like to give up
breastfeeding, to feel like a Bad Mother, a failure for turning to
formula feeding but the blame for that lays squarely with the health
professionals who didn't give me accurate information or the skills to
do the job, with society for destroying our breastfeeding culture in
order to make money out of formula milk and yes, with myself for not
informing myself of where to get accurate information support.
As a first time mother, I spent more time looking at buggies than I did
finding out about how breastfeeding works and how to get good quality
support locally if I was struggling. I have let myself off the guilt
hook as I was terribly naive then about how the NHS works and I thought
that if they were prepared to spend thousands of pounds on producing
posters and pens telling me how MARVELLOUS breastfeeding is, they'd
have spent a couple of quid on training their staff and putting enough
of them in a town near me so that I'd have an evens chance of success.
And when on New Year's Eve I sat sobbing with bleeding nipples and no
midwife due to come for 3 days and no idea at all how anyone could help
me it was no wonder that the lure of the 24 hour Tesco with its formula
solution proved all too much.
It wasn't until 3 years later,
expecting my second child sat in an NCT class - I hadn't done them
first time around - that I discovered several things that all potential
lactactors should know:
1- Your health service almost certainly
doesn't have enough qualified personnel to support you through the
early days of breastfeeding if all is not going well and you should not
rely solely on this.
2 - You probably have a network of trained,
expert volunteers near you which you can access free of charge. This is
more difficult in London and may partly explan why most journalists on
national newspapers do not seem to breastfeed but it helps if you do
your research while pregnant so you are not trying to find good quality
support when you are frantic with a screaming baby.
3 -
Breastfeeding works very well for a lot of women BUT if you experience
some of the problems there is no substitute for a qualified and
experienced pair of eyes to have a look at positioning which causes
about 90% of the problems in the early weeks.
4 - Breastfeeding
should not hurt. Sore, cracked and bleeding nipples are not normal but
if someone can help you correct baby's position then they can get
better very quickly. Do not believe anyone who tells you the baby's
position is right if it is hurting you, get another opinion.
5
-The vast majority of women can produce enough milk for their baby but
they may have to adjust their expectations of how they will parent to
accommodate the normal behaviour of a breastfeeding baby. We no longer
understand what normal behaviour is because we have grown up in a
bottlefeeding culture - so the breastfeeding baby who feeds hourly or
cluster feeds for four hours of an evening or who wants to be carried
all day or who prefers to co-sleep is seen as abnormal, a problem to be
fixed.
6- It's OK to ask for help. In an ideal world we would
have wise women all around us, mothers, aunts, grandmothers and friends
who would all have breastfed or still be breastfeeding their own
babies. We would have grown up watching other women sort out the common
niggles and would not be surrounded by well meaning people who
bottlefed and are managing their own feelings about it and who may not
be entirely unbiased when they say "Oh just give him a bottle, it never
did you any harm." Organisations like the NCT, La Leche League, the
Breastfeeding Network are there trying to stick a nipple in the gaping
hole caused by 30 years of relentless marketing of formula and the
resultant loss of societal knowledge and shared experience of
breastfeeding.
6- Not all health professionals are well trained
about breastfeeding and not all counsellors or supporters have the same
training. Midwifery and health visitor training about breastfeeding is
improving, particularly if your local NHS hospital or trust is involved
in the BabyFriendly Initiative but knowledge and skills and resources
may be limited so do a bit of research beforehand to discover who is in
your area. GP's have widely varying knowledge about breastfeeding.
Almost without exception health professionals are not offered an
opportunity to debrief their own experience and their own baggage can
impact on the advice they profer.
Peer supporters or breast mates or
breast buddies or whatever they are called are local mums who have
breastfed and who have had 2-3 hours of training. This is not the same
as a qualified breastfeeding counsellor who will have trained for 2- 3
years and an accredited qualification. That is not to say that a peer
supporter can't do a fantastic job of listening and supporting but you
may need more in-depth knowledge than that.
7. Breastfeeding
does matter. Sometimes your circumstances make it extraordinarily
difficult or your choices become extremely limited through absolutely
no fault of yours. Women mother these days under all sorts of pressures
and with very little suport. But the reason that we have Unicef working
in this country to increase our breastfeeding rates, the reason that
government gives its mealy mouthed support to Breastfeeding Awareness
Week, the reason that the World Health Organisation, the NHS, La Leche
League, the NCT promote breastfeeding is NOT because of some nostalgic,
rosy tinted longing for the return of some mystic ideal but because as
a society we would be so much healthier if babies were breastfed. Fact.
And if you didn't manage to breastfeeding it most probably isn't your
fault but it isn't breastfeeding's fault either and it most definitely
isn't the fault of your local breastfeeding supporter.
All of
which is why I'll still plug on, offering my support to women both
locally and on the national line run by the NCT because I'm trying to
make a difference to the few I can help not because I'm some superior
being trying to live out some superior race fantasy but because I was
once that mum crying on the sofa who did get warm, non judgmental,
mother to mother support from a volunteer when she most needed it.
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Derbyshire Parent and Child Activities |
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To be included in this listing please contact us. GENERAL DERBY/DERBYSHIREDerbyshire Real Nappies. Advice from a friendly local mum who can visit you at home or
at your local group and guide you through the maze. Attends the NCT Belper Nappucino event at Bumps and Babies, first Monday of the month. Belper community Centre 10.00-11.30am. Contact Lisa on 07917101311 or see www.derbyshirerealnappies.co.uk
BELPERNCT (National Childbirth Trust: Amber Valley NCT offers antenatal classes, breastfeeding counselling and social events for new parents. They also run 2 groups for parents -Monday morning is Bumps and Babes for pregnant women and parents with non-mobile babies. Every Monday 10.00-11.30am at the Community HJall, Bridge Street Belper. Wednesdays is open to everyone with baby or toddler same time and venue. For more information and contact details see the NCT website www.nct.org.uk/AmberValley
Artful Splodgers: Themed messy play activities held at Fleet Arts Centre in Belper on Wednesdays and Fridays. www.splodgers.co.uk Contact Gill or Dawn on: 0845 643 2606 Twistin Tots: Fun exercise and movement activity for babies and toddlers. Currently Tuesday mornings and Friday afternoons. www.twistintots.co.uk or ring Jacqui on 07977 578 359 DERBYBuggy Babes: Power walking in Darley Park on a Monday afternoon and Thursday morning. www.buggybabes.com Contact Beccy on 07968378227. HEANORParent and child group: based at Michael House School with an emphasis on natural play in tune with the seasons. Fabulous garden and kids bake their own bread and are encouraged to play out all year round. Friendly supportive group with singing and a snack drop in 9 - 12:30 Tuesdays, Wednesdays, Thursdays and 1 - 3:30 on Mondays. Only £3 per family. For further information visit www.michaelhouseschool.com or
call 01773 718050. MATLOCKYoga for Pregnancy: at Escape Yoga Centre, also postnatal yoga. www.escapeyoga.co.uk or contact Jane on 01629 760006. |
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Last Updated ( Monday, 01 June 2009 )
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VBA3C, Triumph of Hope Over Experience |
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All
births are a triumph in some measure. My first birth was a classic "failure to progress" yet when I awoke
from general anaesthetic to find my daughter, Emma, at my breast I
felt a sense of awed wonder at the creature my body had produced. In
the days, weeks, months that followed I started to wonder, to regret,
to blame myself for the “failure” I felt myself to be for needing
a caesarean.
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Last Updated ( Friday, 10 April 2009 )
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Read more...
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Before you consent to induction it is worth knowing what the procedures involve and exactly what you are consenting to. Also remember to ask:
Why is this being suggested? (see Induction - Why?)
What are the Benefits?
What are the Risks
Are there any Alternatives?
What does your Intuition tell you?
Is there time to do Nothing, to watchfully wait for a while?
The BRAIN set of questions is a great one for any intervention and is a useful, non confrontative tool for using with your carers. Asking the How, Why, BRAIN questions first might be useful if you have forgotten all the info in this article. Don't forget to ask everyone to leave so you can discuss what you think with your birth partners.
Below is a standard induction process, bear in mind that in certain situations, for example ruptured membranes, some steps may be skipped as moving straight to a drip might be more effective in those situations. |
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Last Updated ( Saturday, 05 January 2008 )
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