When Headlines Are WRONG

I think most people probably know that newspapers are not always the most reliable sources when it comes to conveying factual information. Certain papers tend to sensationalise things and some even tell outright lies to their readers in order to sell more papers. Because the real news is often nowhere near as interesting as the made-up stuff.

What kinds of headlines sell newspapers? Babies dying, sadly, is a big seller and it’s one we’ve seen in the wake of the release of the long-awaited Birthplace Report, which was published yesterday. The Daily Fail notoriously misreported the study’s findings, with a lead headline of

First-time mothers who opt for home birth face triple the risk of death or brain damage in child

  • Half of women who chose home births had to be transferred to hospitals due to complications

Both of these statements are complete lies. Not just minor misrepresentations or misinterpretations of the facts, but actual lies, told to scare the public and stir up an emotive debate.

You may be able to tell that I have absolutely no respect for this publication, or others like it.

So, what is the truth behind this sensational headline?

The Birthplace report really did find an increased risk of death (stillbirth and neonatal mortality), brain damage (infant encephalopathy), meconium aspiration syndrome and bone fractures in the arm and collar bone in babies of first time mothers who plan home births, deaths did NOT make up the majority of these outcomes. HOWEVER, it was less than twice the risk of babies born in other settings, not three times the risk. Also, the actual risk is still less than 1% and the results are looking at the short term only, it is entirely likely that most of these babies are perfectly well after treatment.

Mothers who have children already face absolutely no increased risk to their babies by birthing at home.

There were so few infant mortalities in the study that the researchers decided to compound the results of a range of adverse outcomes in order to produce a study with statistically significant results. I have mixed views on this. On the one hand, it muddies the waters by mixing up the worst case scenario for the baby with a host of lesser problems. On the other, it does demonstrate very clearly just how safe birth is in the UK today (with a less than 1% risk of anything significantly bad happening to a baby, regardless of where it is born or how many babies the mother has had before).

As for the “Fail”‘s other assertion, well actually, it was less than half of mums, about 40%, who transferred and most of them were not for “complications” but for the infamous “failure to progress” and epidural pain relief.

A more accurate, and just as attention-grabbing headline might have read

Low risk mothers who plan hospital births are three times more likely to have an unplanned caesarean section than in any other birth setting

The study found that women planning births at home and in birth centres (both freestanding and attached to an obstetric unit) were overwhelmingly better off than those planning to birth in obstetric units. Women in hospital had a mere 58% chance of having a normal birth, whereas those planning to remain at home had an 88% chance. This study didn’t even touch on long-term results, such as breastfeeding duration or mental health.

These are all low risk women. And their health matters. Yes, we all care very much about babies and no one loves a mother’s baby or wants the best for it as much as she does… but mothers matter too. A healthy baby might not stay that way with a damaged mother and a damaged mother may remain damaged for the rest of her life as a result of her birth experience.

The elephant in the room with these results is… why do women do worse in hospital than in any other setting? The study can’t tell us that, but there are a number of theories. The most compelling to me personally, is that obstetricians view birth as a problem that needs fixing and that they have a tendency to step in and interfere where no interference is actually necessary. In an obstetric-led unit, even though all low risk women will be cared for primarily by midwives, there are always obstetricians waiting in the wings for something to do. At the study launch event at the Royal Society of Medicine yesterday, Dr David Richmond, Vice President of the Royal College of Obstetricians & Gynaecologists (RCOG)  implied as much in his talk when he showed a slide of Mount Everest and quoted Sir Edmund Hillary, who famously replied to the question of why he climbed Everest with “Because it’s there”.

Those of us who have taken an interest in normal birth and taken the time to investigate how birth works, are aware that birth goes the smoothest away from time limits, bright lights, loud noises, routine interventions and alien environments, i.e. at home. So the results of this study are no surprise. Women do best at home.

I think it’s very important for women to have access to the right information, presented in the right way, to enable them to make choices for their births, so let’s just compare the statistics for a moment.

  • A first time mum has roughly 0.5% chance of anything bad happening to her baby in hospital or in a midwife led unit. She has a less than 1% chance of anything bad happening to her baby at home. At home her baby is nearly two times more likely to have an adverse outcome.
  • The same mum has a roughly 15% chance of an instrumental delivery (ventouse or forceps) in hospital and 4% chance at home. In hospital it is over three times more likely.
  • She has a 10% chance of a c-section in hospital, less than 3% chance at home. In hospital it is over three times more likely.
  • There is a 23.5% chance of having her labour augmented in hospital (with all of the associated risks to both her and the baby that come with that) and just 5.4% chance at home. In hospital it is over four times more likely.

I’ll leave it up to each reader to digest those figures and decide for themselves where their preference for birth place lies, but do remember that these are all like-for-like mums, they are all low risk, so what these numbers suggest is that it IS the place of birth that influences the numbers. The mere fact of being in hospital makes these interventions more likely, and avoidable by staying at home or birthing in a birth centre (which tend to come out roughly the same as home or somewhere in between the two). It’s not that more women in hospital need these interventions because they are high risk.

Next time you read a sensational headline in the press, take a moment to think about what they aren’t telling you or the fact that they could actually be telling a barefaced lie.

Sleep Training Our Munchkin

We finally decided that the time is right to sleep train the Munchkin. He is still largely parented all the way to sleep, with a good wind down routine followed by me or hubby sitting by his bed, holding his hand (at his insistence) until he falls asleep. Previous attempts to leave the room with him still awake have resulted in meltdowns, or at the very least a shout of “No!”

With a new baby on the way, we can’t possibly spend 2 hours every evening putting our nearly 3 year old to sleep, so he is going to have to learn to do some of it on his own. Up until lights off point, nothing has changed, but the method of sleep training we have embarked upon is that of Controlled Giggling (sadly not covered in the book, pictured left).

It’s very simple. The light goes off, his night light goes on. He gets cuddles and kisses from us both and we leave the room. When he giggles we ignore him for increasing increments of time, then go in, settle him back down and then leave again. It hasn’t yet got to the five minute mark as he comes running out into the hall grinning and laughing long before then, so one of us escorts him back to bed and does the above.

The first two nights of this, he only emerged from his room, red faced from laughing so hard, twice before going quiet and going to sleep. Last night, however, he regressed somewhat and it took a good 7 or 8 attempts to resettle him before he gave up and went to sleep. I hear that this is normal and that our approach should remain unchanged. If, however, he takes to deliberately laughing so hard he vomits, in order to manipulate us, we should start lining his bed with towels, so that we can clean up as quickly as possible without looking at him. He currently has a 2.5 tog child’s duvet, but we are considering upping this to 14 tog for the winter, as per the very excellent advice available from reputable sleep trainers online.

Now I just need to find an appropriate sleep training method for myself, as I’m currently up and writing this at 3.40am, having tossed and turned for an hour and a half due to terrible back ache. I wonder if the more aggressive sleep training method, Giggle it Out, would be effective in my case? I’ll have to talk to hubby about it as he would have to completely ignore me no matter how hard I laugh or for how long. It’s a lot of pressure on him.

Night all.

Montessori Nursery a Big Hit

Typical Montessori Learning Space

Our plan is to home educate our children, for a variety of reasons, we feel it is the best option for our family. For some time now I have maintained that the Munchkin would not be going to nursery for this reason. Why prepare him for school when he isn’t going? But we have also always said that we would remain flexible and meet the actual needs of our children, rather than adhering steadfastly to some sort of super-plan.

Well, I’m getting bigger, slower and more tired. The Munchkin is getting bigger, heavier and faster. Oh man, is he hard work these days! An absolute joy, don’t get me wrong, but he is hungry for more interaction and more new people and places and I am struggling to keep up with him or get him out to enough groups to satisfy his thirst for activity.

There are lots of home education activities in our area, we have a thriving HE community, with several children three years and under, but “our area” is actually county-wide and not all of the activities are suitable for children as young as him. One of my main motivations for finally learning to drive this summer was to get him out to more groups, as it was proving impossible to do so relying solely on public transport. However, I’m still not getting to any HE groups and only sporadically managing generic under 5’s groups as my energy levels are somewhere in the sub-basement.

So, after some long discussions, hubby and I decided to check out our local Montessori nursery, with a view to the Munchkin having a couple of sessions a week there to give me some relief and him some much needed play time away from home. We have a couple of friends who send their little ones there and are very happy with it, we generally like the Montessori approach to education and are planning to utilise bits of it at home ourselves.

After exchanging a few emails with the principal, hubby and I took the Munchkin along this morning for a “quick half hour” visit before hubby had to be at work. That “quick half hour” turned into three hours of some of the most positive play I have ever seen the Munchkin engage in. Given that hubby had to be at work, we even left the Munchkin there alone for half an hour while I drove hubby to the office in the next small town and then came back again. Not once did he even ask for us while we were gone!

The Munchkin isn’t shy, he will very happily chat to complete strangers in a café , on a train, in the supermarket, etc. But usually when we go somewhere new that is clearly a designated child space; be it someone else’s home, or a group, he sticks close to me for a few minutes and prefers to play on his own for the most part. Even with other children that he knows well, it can take an hour or more to warm up to that child enough to play with them, as opposed to side by side but independently. In groups of more than two children I have never known him interact with others, he seems to prefer his own space and to do his own thing. For this reason, I have been convinced for some time that nursery would be the wrong setting for him and been content to stick to play dates with one or two mum friends and their children at a time.

Today was a whole different story. He was his normal, cautious self when we arrived. It took a bit of coaxing to get him into the main play room from the entrance way, but once he was shown where the train set lives he came completely out of his shell. Within five minutes of arriving he was not only playing happily without either of us, but he was engaging with the other children too. He did ask me to join in with him a few times over the course of the morning, and was keen to show me what he was doing, but I think had I not come back after taking hubby to work, he wouldn’t have missed me at all.

At about 10.30 the children decided to play outside. There is no structure to their day, they follow the children and apparently have at least one but usually two sessions of play outdoors every day, no matter the weather (love that part, hooray for puddles!). The Munchkin was in the middle of the group as they burst out of the door and he had a wonderful time sweeping the leaves and piling them into a little wooden trolley and then working with a little girl to bury a tricycle with them. We have had to abandon arts and crafts as he hates having anything he perceives as mess on his hands. Even meal times have become a challenge, with him asking to be cleaned every time food gets on his hands. But this messy play with the leaves was totally acceptable to him and he only asked for his hands to be cleaned once mid-play, there was even some reluctance when I cleaned them again as we were getting ready to leave.

I was itching to get off, feeling that I had had all of my questions answered and having other things planned for the day, but it took over an hour of gentle persuasion and bribery before we left. Even “Shall we see if nana is home and go to her house?”, which is normally enough to convince him to leave whatever and wherever we are, was met with the reply “No. Busy playing here.”

I was stunned, to say the least. Lunch at a café was passed up, home to his own trains returned “No, we can’t do that yet.” and all afternoon I was being asked if we were going back to “that place” again and his absolutely adorable “pleeeease”.

I managed to convince him to leave after using all of my usual tools, including the tactic of letting him do one more thing that he really wants to do and then doing what I want him to do. That was the winner in the end and we left with, surprisingly, no tears and a cheerful goodbye to everyone. We got my odd jobs done and had lunch in a café , as he was finishing his lunch he grinned and asked “We go to nana’s house now?”, clearly remembering my attempt at bribery from at least two hours previously. So one quick phone call to my mum and we were on the road to my parents’ place, via home to collect more clean nappies, as I hadn’t planned to be out all day!

He couldn’t wait to tell nana and “Ash” (his name for grandad) all about nursery and even when we went back to hubby’s office to collect him at the end of the day, the Munchkin was still asking to go back to play at “that place”.

I remarked to hubby about the level of development in the Munchkin from one short morning at this place; the confidence and independence, the willingness to get mucky and the eagerness to return are all fairly new to us.

It’s a good job hubby and I were as impressed with the place as the Munchkin is really, but I’m not sure what we’ll do if two half days a week aren’t deemed enough by him, as we really can’t afford more! Roll on third birthday and 15 hours of free childcare!

We certainly won’t be making any rash decisions at this stage about long term educational plans, but for now, this arrangement looks like it will be a winner for us all and maybe we can look at the idea of flexi-schooling later if this nursery gets its free school status approved for 2013. I’m still a firm believer in HE, and that is still my preference, but who am I to deny my little boy something that he gets so much out of?

Switching Off and Being a “Normal Mum”

Twice in just a few days I have been in situations where it is probably best to switch off my campaign head and shut up, be a “normal mum”, whatever that might mean. The first of these was the first of two Natal Hypnotherapy workshops that hubby and I are attending in preparation for this birth and I didn’t do so well. The second was my aquanatal class today. I did better.

I’ve always found it hard to know when to shut up and keep my opinions to myself and have probably pushed a fair few people away because of it in the course of my life. When my passions are raised they tend to spill out of me, but I’ve worked hard to get it under control and generally I think I do a better job now than ever before.

When it comes to birth, it’s a bigger challenge than most issues I’ve felt passionate about in my life. It’s such an intimate topic, birth is the single most significant physical act that a woman embarks upon and also the one fraught with the highest emotional investment too. I know that birth can be amazing and I know that all women deserve excellent maternity care. I know that there are fundamental, systemic problems with NHS maternity services that prevent the majority of women from having the births they should have. I hate seeing women being trampled on and abused by their care providers and it makes me angry and deeply saddened that I can even use the word “abused” there and know it to be no overstatement or falsehood.

Last Friday at the Natal Hypnotherapy workshop, I had to tell myself not to go to it expecting that I would know everything already and to accept any new knowledge or tools presented to me. At one point, having answered every question about hormones and birthing positions that we were asked, I actually apologised and made an effort to keep my mouth shut to give one of the others a chance to answer something. I felt a bit like Hermione Granger.

One of the other ladies on the course is also planning a VBAC and I couldn’t stop myself from making suggestions about which interventions she might wish to think more about. I don’t think I came on too strong there, but over lunch discussion turned to placentas (yes, over lunch) and I went and mentioned the fact that we’re planning a lotus birth. I think the others were mostly just intrigued, until I went a step too far and mentioned consuming the placenta as another option. I suspect I came away from lunch looking like a very weird hippy.

This afternoon was my aquanatal class, which I go to for the exercise and “me” time. After the class we sit in the café for a chat and the first time I went it was just me and the two midwives who run the class. We had a fantastic chat and I told them about what I do and which groups I’m involved in. They are lovely ladies, very keen on what they do, which is helping women keep fit and healthy in pregnancy and they have their gripes with the NHS, and so no longer work within it. However, I do suspect that they don’t see quite the same problems that I do.

Today there were others present, one lady due in a month or so and another who had a home birth a few months ago, another lady due early next year. I was very grateful for the home birthing mum’s presence, as she was able to say some of the things I would have loved to say, but in a much more palatable way than I can sometimes be guilty of. She was a normal, non-campaigning mum, a mum who only breastfed her eldest for a few months (compared to my 2.5 years) and who told us that her home birth “bloody hurt” and that she had a third degree tear and had to have a spinal afterwards while being stitched up. She was absolutely supportive of home birth and said she would do it again if she ever has another baby, but she definitely wasn’t ever going to come across as the dreaded hippy-type or militant birth campaigner. Like me.

For the most part I just nodded in agreement with her. When the nearly-due lady asked if it was possible to hire a midwife privately, as hers is so rubbish, I was able to espouse the virtues of independent midwifery and I also mentioned doulas. I think I managed to toe the line I find so difficult, that of switching off my campaigning head and just being a normal mum, talking to another normal mum and hopefully pointing her gently in a sensible direction that will help make a positive birth attainable. Maybe next week she’ll be telling us that she’s booked a home birth and hired a doula. Maybe even an IM. I hope so, for her sake.

Shopping for the Baby

So, I bought THE jeans. The Boob Jeggings. I grabbed a bargain on eBay, new with tags, and they are excellent, a little long for my average height but they fit great otherwise and do the exact job I bought them for, they may even be comfy enough and flexible enough to wear to my yoga class!

I was talking to a friend today about shopping and how my shopping behaviour has been different during this pregnancy compared to last time. In part it’s down to money, hubby and I are better off this time around than a few years ago so there is less holding me back from clicking on “Add to basket”, though we are not really as affluent as my recent shopping habits would imply and I really must try to restrain myself more. More

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