Tag Archives: birth

So we just cross our legs?

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Two days on and I’m still feeling cross about it!

Yes, it’s the Daily Mail again with the outrageous headline that babies born just one week early risk serious health problems.
On how many levels can a story be hurtful?

It’s carefully presented as being a warning about the dangers of elective caesareans which tend to take place at 39 weeks (and in so doing again perpetuates the attitude that having a caesarean is about being too posh to push). 
But look at the statistic it presents… when it comes to caesareans, up to 7% are elective, apparently – so that means that about 93% of caesareans are emergency or planned? 
That’s hardly an overwhelming level of too-poshness. 
There is a question though over why we have such a high level of caesareans over all – double the World Health Organisation’s recommended level (but why is there a recommended level?  Surely this was about demedicalising birth in e.g. the former Soviet Union? Could this be a formula babymilk style issue where something recommended for a good reason and has unintended consequences for some mothers?). 

But hold on, it gets worse… “the full 40 weeks”? 
My son arrived at 38 weeks and I was assured that he was full term. 
A day or two earlier of course he would have been premature, but I needn’t worry as 38-42 weeks is full term and perfectly normal. 
That of course assumes that my due date was correctly calculated in the first place (I didn’t know, when first pregnant, that the length of your menstrual cycle plays a part in those first calculations – why would I know that?) 
I didn’t expect my waters to break at 38 weeks and my son to arrive less than 12 hours later. 
I’d have preferred him to hang on in there.  I wasn’t completely ready, the house was not tidied and I hadn’t even got my overnight bag packed!
But I turned out to have pre-eclampsia, and he had IUGR, plus some placenta problem so his hormones triggered labour so he could survive.
How was I supposed to keep him in there longer, exactly?
And, given the risks we were both facing, surely it would be ludicrous for me to worry about anything more than ensuring we could both live and thrive?

The thing is, there’s no real consideration in the article about why a baby might be arriving early.
It is entirely possible that babies arriving earlier than 40 weeks are doing so – like my son who was a natural birth and my niece who was an emergency caesarean – because they are experiencing difficulty in the womb.

But how much does that extra week really matter?
If children born 24-27 weeks tend to have a greater propensity to special educational needs (and if the article is right that the level is nearly 7 times more than those born at 40 weeks, then roughly 300 in every 1000 born that early), then it seems reasonable to say that prematurity brings risks. 
But there’s a huge difference between saying that,  and stressing about the following statistic:  for every thousand children born at 39 weeks, 47 will have SEN. For those born at 40 weeks it’s 44 children.  By the way, overall in the school population, in 2008, 2.9% of children had SEN.
I just wonder – given all the other factors that can affect SEN, whether this is actually sufficiently clinically significant to change from planned caesareans taking place at 39 weeks to planned caesareans at 40 weeks?
In any case, the article itself makes clear at the end that respected medical opinion is divided on whether caesareans at 40 weeks would actually be any safer anyway!

But the thing we tend to forget in the developed world is that birth is not a safe thing. 
The truth is that birth is a process over which we have less control than we like to think. It’s raw and bloody and painful and a reminder that what we are doing has significance.
And we still have very little idea about how children develop their mental faculties at such an early stage.
But I’m pretty clear that stress is a Bad Thing – overall, and in pregnancy in particular.
So please Daily Mail, don’t run this sort of scare story.
It upsets parents on something over which a phenomenally high number of them have absolutely no choice or control at all.
It’s not as if we can all just cross our legs and keep the babies in a little bit longer.
Babies come when they want to.  And if they don’t – that’s why the caesarean help is available.

Penelope Trunk unpacks a difficult issue

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Penelope Trunk didn’t mean to do us a favour.
She may be a famous social network expert (over 20,000 follow her Twitter feed, me included), known for the combination of business and personal tweets she makes, but it’s one tweet combining the two that has caused controvery both in the USA and here in the UK too.
Last week she tweeted: “I’m in a board meeting. Having a miscarriage. Thank goodness, because there’s a fucked-up three-week hoop-jump to have an abortion in Wisconsin.”

There’s been a rush to judge her, and she’s now written a “Comment is Free” article for the Guardian explaining that she’s not a monster.  She already has children, hadn’t intended to be pregnant, was at great risk of having an unhealthy baby, her partner doesn’t believe in abortion and frankly pregnancy and miscarriage screws with your emotions.  She didn’t mean to trivialise miscarriage or indeed abortion.
I’m witholding my judgement on all that.  I think the wording of the tweet came across as callous, but miscarriage messes you up a bit – I guess she deserves the benefit of the doubt.  She certainly doesn’t deserve the death threats.

What she’s managed to do, without really intending to, is to bring the intensely personal grief of miscarriage into the public domain.

Because a miscarriage is intensely personal.  And because it’s personal and tragic, you’re not “meant” to talk about it.
And most of the time you just have to get on with it.  One Evening Standard columnist talks about the choice between passing it off as flu or strapping yourself into a giant pad and heading off for that meeting anyway – as if having to ignore the little tragedy is a price women just have to pay for the chance of being in the workplace.  I tried it – you are not necesarily going to be able to do this and act normally!

And all the while the extent of your loss is obvious to you – the dull stomach ache, the parody of a normal period, stuff that I barely want to recall let alone write about.
Your body responds to being pregnant- for anyone that hasn’t had it it’s rather unpleasantly like the worst PMT you’ve ever had: heightened sense of smell, weight gain, really uncomfortable breasts.
And you can get all that even if you miscarry, continue to have all that even when losing what could have been your baby.
Actually the weight gain is a complete pig of a reminder.  You can’t help but think about Catherine of Aragon, first wife of Henry VIII who is known to have had a number of miscarriages.  And she became bloated and unhappy and Ann Boleyn managed to tempt her husband away from her. I hate the way miscarriage can make your mind work.

And the grief.
It’s the grief that’s hard to explain. What are you actually grieving for?
And that’s where the abortion point comes back into play.  It would be quite hard to explain to people who only really think of a six or seven week old embryo as just a ball of cells that your mourning a life that didn’t get to happen.
You’re grieving for what might have been, upset that all the excitement, the future planning that you’ve done explicitly or subconsciously has just come to an end.
I’m not sure whether medical staff still refer to miscarriage as spontanteous abortion, but some of the older literature does and it seems to assume that comfort can be draw from the fact that it occurs usually because there was something wrong with the developing embryo.  For what it’s worth, no it doesn’t make you feel much better.
Your hormones have also got all geared up for pregnancy and the shock of their readjustment leaves you on the verge of tears a lot of the time.

Then there’s the guilt.
It feels like everyday there’s a new new story about something terrible that you could do to your unborn child that would result in loss or permanent disability.  And when the miscarriage starts you wonder – what if I hadn’t carried that box? What if I hadn’t had that glass of wine/ piece of blue cheese/ dodgy prawn/ slightly undercooked bacon?  What if I’d managed to lose the weight? What if I’d taken the exercise a bit easier, or done a bit more?
What if I’d managed to be less stressed?
So again that conspires against anyone talking about it.

I’ve not really experienced the relief that Penelope Trunk describes, but then she’s over 40 which brings greater medical risk, and already has the number of children she wants.  And although the language she used to express her private thoughts was what really shocked (convention has it that every child should be wanted, miscarriage a tragic loss not something to be celebrated) it is legitimate to feel like that.

Family planning is still a modern phenomemon – in our want-get society of instant gratification we forget that this stuff is not easy.
Even in my grandparents’ generation not every child was expected to live to adulthood, and having ten children was not just about a lack of contraception but an acknowledgement that not every pregnancy  would result in a child and not every child would make it through childhood.  The whole process of conception, pregnancy and raising small children is a real reminder that while we might try to live ordered lives there’s a wild, uncontrollably biological side to our lives and we have to accept and live with the consequences of what happens to us.

At my age and when you have a child of toddler age, you and the other mums you know are likely to be trying for a second child (possibly third if real gluttons for punishment – the quantity of work per child is not simply twice as much but apparently much more even though you know more what you are doing). And, if you get talking about it, you discover just how many people you know that have had a miscarriage.

Penelope Trunk says “it’s part of being a woman”.  I think I know what she means.