Category Archives: Maternal

Tackling a Four Letter Word

  

I’ve been reading a lot of interesting posts on Twitter lately discussing a four letter word which is rapidly becoming the elephant in the room as far as providing maternity care goes so I thought I would have a go at trying to give my perspective via a forum which isn’t limiting me to 140 characters.

The concept of RISK is emotive. Being ‘risk averse’ seems to be something which is considered negative, a form of defensive practice and, from some of the posts I’ve been reading, not something that midwives should be supportive of if we want to be considered truly supportive of the birth process. However, The Cambridge English Dictionary defines the term as being ‘”unwilling to take ​risks or ​wanting to ​avoid ​risks as much as ​possible” which I have to admit I feel comfortable with and, should anyone wish to evaluate my practice, would be happy with that description.

Alongside the subject of risk is the statement I see repeated with almost the same frequency that ‘a healthy baby isn’t all that matters’. To contextualise, the point being made is that outcomes should also be measured by the mothers experience of birth and not the condition of baby alone but there is the risk that this could read, to some, that the experience is more important than the outcome and that is wrong.

Being risk averse does not mean the primary focus is on the baby, there are many variables involved in a good outcome. A healthy baby does not mean that the mothers wishes have been ignored, to suggest that the two are mutually exclusive is irresponsible and does nothing to promote trust and respect between families and professionals.

I liken the concept of risk management in pregnancy and birth to crossing the road. In both scenarios there is an identified risk: that statistically despite this being an everyday process, there will be occasions where there will be an adverse outcome. That is a fact, not a scaremongering tactic, and we do women, their partners and their babies a great dis-service if we choose not to acknowledge this in case it prejudices the decision making process.

To minimise the chance of an adverse outcome when we cross the road we would need to identify potential hazards, for example the obstruction to the drivers vision which may prevent him from seeing us cross, or the 60mph speed limit which gives us less time to cross, and look for a solution which enables us to still cross the road, but in a safer place where the desired outcome of reaching the other side of the road in one piece has a greater chance of being achieved. The same can be said when discussing and planning maternity care, and in particular, place of birth.

Some women live on that quiet country lane which is quiet, calm and traffic is infrequent. She will have had a healthy, uneventful pregnancy and, after discussing the options of where to cross the road (or give birth) will have many options open to her where the outcome will still be the same, however she must still be aware of the fact that she cannot predict the rogue driver who may decide to make an appearance at the time she chooses to cross. Caution should still be applied, even on an empty road.

For the woman who lives near the motorway (or has a slightly more complicated pregnancy) the traffic may not be so calm, but she still wants to cross the road safely. The potential hazards need to be identified so that she can decide where to cross and it may be that the traffic is so heavy she may need to seek an alternative way of getting to the other side, however, there will be times when the traffic slows and even stops so that, if she is ready, she can make her way safely across without the help that is available.

To manage risk it has to be identified. Acknowledging it exists and looking at how to minimise it is good practice. Risk taking rarely saves lives except in disaster movies and patient safety should not be considered as the antithesis to patient choice. Good communication skills, knowledge sharing and respect all contribute to ensuring the two can work together in providing a positive and safe outcome for all. 

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Good enough IS good enough.

  
I read a post this morning from a friend who was feeling guilty because she lost patience with her toddler and wondering how to manage her frustrations. Following this I have just returned from what can only be described as the shopping trip from hell with three children who managed to fight and complain their way around the entire store. Loudly. 

It got me thinking on how, as mothers, we see the fact that we have become annoyed or frustrated as a ‘parenting fail’ which only serves to increase our feelings of guilt, and how in doing so we are probably doing our children a great dis-service.

I have to confess, I don’t feel I’m any different to any of my friends if the conversations we have about our children are anything to go by, but there must be some out there who manage to remain emotionless upon discovering their entire Clarins skin care collection has been emptied down the toilet, or their beloved progeny has taken a marker pen to their newly decorated bedroom otherwise we surely wouldn’t compare ourselves unfavourably against them. 

Surely if we suppress our own emotions in front of our children we are encouraging them to suppress their own which is not helpful when trying to teach them how to process their own thoughts and feelings and deal with them effectively.

There is a line of course, witnessing aggressive and intimidating behaviour is incredibly damaging for a child emotionally, but for a child to see that mummy is feeling angry at the moment so is taking some time out to calm down teaches them that a) anger is an emotion everyone experiences and b) there is a non-destructive way to deal with it. 

Sensible parents don’t expect perfection from their child but by expecting perfection from themselves they are enforcing an ideology that just ‘trying your best’ simply isn’t enough.

It’s perfectly OK for mummy and daddy to have a disagreement in front of the children. You are teaching them that people may experience conflict but there will be a way to resolve a situation through talking and listening. You are also teaching a very valuable lesson in how it is important to hold on to your own thoughts and opinions and that everyone has a right to be heard.

I see parenting as a huge privilege and acknowledge that there are many people who are unable to embark on this journey for many reasons but I don’t think this should in any way detract from the fact that it is incredibly hard work.

We are helping new humans join this society and we should try to be as open as possibly in encouraging them to embrace their humanity in all its glory. In other words it’s ok to tell your child when their behaviour is having an impact on you. Good or bad! 

I don’t want to be perfect. I have no desire for my sons or daughter to grow up thinking that a good mother resembles a Stepford wife with low expectations and infinite tolerance to intolerable behaviour because I know that they deserve better in their future lives and I don’t want them to spend their their lives feeling let down when they discover that perfect doesn’t exist.

Humans are, by definition, flawed. We get emotional because we are emotional beings, not robots. Seeing emotions used in context will teach our children far more than suppressing them until they jump out shouting ‘SURPRISE!!’ at the onset of puberty.

Perfection is one heck of a target to set. I prefer ‘good enough’ because you know what? It really is. 

Baby Whisperers Please Pipe Down

  
People who know me well know my feelings on so-called ‘parenting experts’. I have been known to ‘relocate’ a certain publication which we midwives know and loathe to the ‘Facism and Nazism’ section in Waterstones (other book retailers are available) and would actively encourage any of you reading this to do the same. 

It’s not that I have an issue with people offering advice, it’s a fact of life, especially when you are a new parent, and some of it you might even take! The issue I have is people who prey on the fears and insecurities of these new parents by offering them a solution to their perceived lack of knowledge, or a becon of light to guide them through the fumbling darkness in the form of….a book!

The idea of these books/baby bibles or whatever you wish to call them is that they tell you exactly what you should do, at what time and for how long etc and eventually you will end up with what television presenter Eamonn Holmes and his partner Ruth Langford described, after following a particular regime, as a ‘clockwork baby’ (which was, to them, a good thing).

Gina Ford published a strict regime in her “Contented Little Baby Book” encouraging parents to break their day down into five minute slots in order to get the newborn baby into a routine as soon as possible. Of course once you have actually had a baby you realise pretty quickly that achieving anything in five minutes is nigh on impossible (unless it’s a shower!). 

The baby should be woken and fed at 7am, parents fed by 8am then the baby fed (in the nursery!) every 4 hours until the last feed at 6:15 whereby parents must not, under any circumstances, make eye contact with their child in case it gets excited! Seriously?

We, as a family when our first born child made his entrance into the world, failed miserably at the first hurdle. Rather inconveniently our son was not born with the ability to read so had absolutely no idea what he was supposed to be doing in regard to this regime. What he did seem to know, rather instinctively, was that he needed to feed more frequently than 4 hourly and certainly had no intention of fasting after 6:15 no matter what Gina Ford said! 

Eye contact was unavoidable. Gazing into his eyes became a favourite pastime in our household and it soon became apparent that he was in charge and we, as his parents, were simply put on this earth to to cater to his every whim. Resistance was futile. Once we accepted and embraced that everything fell into place.

Babies are not born with the ability to manipulate. They only know what they need and when they need it. They are actually very accomplished communicators, you just need to tune in to what they are telling you and trust me, they have so much to say.

Watch your baby, talk to him and watch him mimic your facial expressions even from an early age. He is constantly learning from you and the early stimulation he receives from you will set the stage for how he learns and interacts with others in later life. Loving interactions with caring adults strongly stimulate the brain causing synapses to grow and existing connections to get stronger. Connections that are used become permanent, those which are not used ‘die’ and are irreplaceable. 

Gina Ford also advises parents to leave their child to cry for up to an hour so it will learn not to always expect to be picked up.  Why would we want our child to not expect to be comforted if he is upset or needing reassurance? The child that is left to cry doesn’t stop because he has suddenly acknowledged the error of his ways. He has stopped because he has become exhausted and realised that crying is futile because nobody will come anyway. 

Parenting is one of the hardest ventures any of us will ever embark on. The pressure to be perfect is immense, after all if we get this wrong we risk our child’s future happiness/life chances/mental health…etc but do we need perfection and if so, who gets to decide what perfect actually is?

I have encountered so many parents who have been reduced to tears and left with huge feelings of inadequacy because they have been unable to get their two week old infant into a routine which includes sleeping through the night, and are having nightmares about their child becoming a future delinquent because they ‘overslept’ and gave the 7am feed at 7:30. 

Enough! 

Parenting means to prioritise your baby’s needs above your own. It’s tiring and demanding but nobody said this parenting malarkey was easy. Feed your baby when he is hungry, cuddle him close, sing and talk to him and enjoy these interactions. These days pass so quickly and you will never get them back. Trust your instincts, and his. You know what you need and so does he. You know your baby better than anyone else and YOU are the expert on your child. Babies do not need routines, they need loving, responsive parents who nurture confidence in their child by providing the assurance that they are there to catch them when they fall. 

Baby Whisperers have too much to say and they need to pipe down.