Wednesday, 7 June 2017

London Bridge Won't Fall Down

I have a new baby. MissA is just three weeks old and so I live in a world where normal time is suspended. Day and night are a continuous blur where sometimes it just happens to be light or dark. Where I long to sleep all the time but could be summoned from that slumber at any moment. Thrown back into the cycle of feeding and burping and changing, that can stretch and shrink at random whenever I think a routine may be emerging.

So when the terror attacks in Manchester, and then London happened I was drip fed the news every few hours through the night as I lay in darkness, feeding my baby and scrolling through the crowd of information and misinformation on twitter. 

Perhaps it is the sleep deprivation and the surging hormones, but these attacks felt far too close. My Mum is from Manchester and I spent a lot of time there as a kid, visiting my Gran. The youngest victim in that attack was barely older than MissE. She wore the same supermarket school pinafore in the pictures on TV.

London Bridge and Borough market are my manor. A few minutes walk up the road from our old flat, the flat we brought our first baby, MissE, home to after she was born, the flat we returned to after many nights out in the local bars and restaurants before she arrived. The flat where I decided to rename my blog after a silly in-joke from school and the borough where I live, Southwark.

But what I felt most, in the glow of my little phone screen, was sadness and frustration at the utterly pointless loss of life.

I  am exhausted from looking after my tiny new baby, I am hurting and bleeding from her birth and I know it will be months if not years before I get a decent nights sleep. But oh how much I love her.

Most, hopefully all, of those who died, even the killers themselves, have been the subjects of that love. They have been the most precious thing in the world. Held and fed and cared for through long, exhausting nights, by mothers who sought no reward other than to keep them safe and see them grow. What right has anyone to take those much loved people away? Ordinary, joyful, young people who should have given their mothers so many more years of comfort and worry and love.

What is the point in it? London has been attacked forever. Alfred The Great saw off Viking invaders more than a thousand years ago. Guy Fawkes tried to blow up parliament in 1605 and we've turned it into an excuse for a party. The IRA, although their tactics were different, did far more damage than this during the bombing campaign of my childhood. Non of these attackers won, none of them changed our way of life and they never will. So why are people still trying?

I don't believe this is truly about religion. I'm no expert but it seems to me to be more about angry, entitled young men who just happen to have latched on to this particular cause to make themselves feel more important then their lives suggest they are. If they couldn't claim to be acting for their god they would just be picking fights in nightclubs or abusing their girlfriends like so many others who feel the world owes them whatever they want. 

The world doesn't owe us anything, we don't deserve flashy cars or designer clothes, we aren't entitled to anyone's love and other's aren't compelled to share our religion or the opinions we spout on the internet. But we do all owe it to each other to remember the tears and pain and exhaustion of those who raise us. That has nothing to do with religion or nationality. Whoever we turn out to be we were all once tiny, new and precious. 

London bridge isn't falling down. Young girls aren't going to stop screaming with excitement at pop concerts. Young people aren't going to stop moving to London and drinking and chatting in the bars and restaurants. Perhaps there will always be someone with some cause who wants to change that but it's been a thousand years or more and no one has managed it yet. The never will.

Thursday, 25 May 2017

Better Postnatal Care

Our new baby, MissA is here. When I'm a bit less sleep deprived I'll write more about her but for the moment I want to share an old post. 

The Mumsnet Better Postnatal Care Campaign began not long before MissA was born, when the subject was very much on my mind. Even when facing a potentially complicated Cesarean I was often more scared of the ward afterwards than the surgery itself. That's because of what happened when my eldest child, MissE was born. That birth was long and terrifying but what followed only added to the trauma and has stayed with me ever since. It took me almost six years to be able to write about it but I'm sharing that post again now in support of the Mumsnet campaign:


I arrived on the postnatal ward of a busy London hospital at some point on a Tuesday morning. I was oblivious to the time by then, days and nights had blurred together as the straight forward, natural birth I had planned (and foolish assumed was pretty much guaranteed), had taken me from wallowing in the birthing pool of the midwife unit to, eventually, lying shaking and terrified on the operating table. 

I do know that my daughter was born by emergency caesarean at 2.33am. Afterwards I was taken back to the delivery room for a few hours. I hadn't slept since the previous Saturday night, my husband had done a little better but was still extremely tired. He dragged out a sort of school gym mat that was propped in the corner and fell asleep on the floor. My beautiful new daughter dozed peaceful in her little plastic crib next to me. I was utterly exhausted, I should have slept but I couldn't. I'd been convinced of the very worst when my baby was whisked away, silent and unseen behind the blue surgical screen. But even once she was sleeping safely beside me I couldn't relax, I couldn't let go of the fear that something might happen, that someone needed to stay awake and watch her. At some point one of the midwives who had looked after me earlier in my labour popped in to say hello as she started her next shift. She'd been home, probably seen her family, slept, eaten. This was a whole new day for her but for me it was just a continuation of a timeless blur, I barely recognised her and couldn't speak to thank her for her help, whenever it was that she had helped.

I don't remember much about that day after I got to the postnatal ward. I was wheeled down on my bed, unable to move. The staff on the delivery ward all cooed over how beautiful miss E was with her full head of dark hair. I kept wondering if this was really my baby, I already loved her fiercely but how could something this beautiful have come from my ugly body? Had some switch been made behind that blue screen? I told myself that that made no sense, but still the doubts crept back.

I do remember that night though.

For a while it seemed that everything would be fine, I was the only person in a four bed room and at some point the lights were dimmed and I lay down, with one hand resting protectively on the tiny crib, and started to drift into sleep. I looked at the time on my phone, amazed I'd been awake for so long. An hour later I was woken up by voices and the clanking of equipment as another mother was brought into the room. I never learnt this lady's story. My best guess is that she was readmitted as her baby was jaundiced and had to be put under a lamp. Whatever had happened, the mother was clearly in desperate need of help herself. She spent the rest of the night pacing up and down the room, rambling and shouting, I couldn't make out what she was saying or in what language, I had no idea if it was directed at her baby, herself or maybe at me. With hindsight I know she was harmless, that I should have tried to help her but that's not what I thought at the time. At the time I felt extremely vulnerable, I still couldn't move and I was terrified of this "crazy lady"* and what she might do to me or my baby, the baby I needed to protect. So I did what I could and lay awake and vigilant all night. Once, a midwife came in and asked her to be quiet, but then they left us alone for the rest of the night. I should have called them, asked them to do more for my sake and hers but I was too scared that she would over hear me complaining and then take her revenge once the midwife's back was turned. Our room was at the end of the ward, out of the way and I had already learnt that the call button could wait twenty minutes for a response, if anyone came at all.

By now time had definitely returned and I was acutely aware of it. I watched the minutes and hours tick past, snatching glimpses of it on my phone screen, hidden under the bed sheet. Until it was just about morning and I thought it would be ok to call my husband. To shake him out of his much needed sleep and ask him to come back in the moment visiting hours began.

I remember a little more of my second day on the ward, there were family visitors, all delighted to meet the first member of a new generation, I felt the need to tell them all about her birth but I slowly realised, everyone was there for the baby. Not me. At some point we discovered that I still had a catheter in and the bag was full so it was removed, along with the cannula that had been tugging at my veins for days. I desperately wanted a shower but wasn't sure if I could, was it ok to get the scar wet? Would I even manage to stand in the room alone? Was I allowed? I managed it in the end, trying hard to get clean without actually looking at my body, trying to leave no trace of my blood in the shared bathroom.

By this point I'd been moved to a busier room, I couldn't help overhearing the conversations with the lady in the bed opposite. She had a new baby, just like me, but she had no where to take him home to and was waiting for a bed in some kind of hostel. How dare I complain in the face of that? What right had I with my lovely husband and nice flat to demand more time of the staff?

I remember the next night vividly too, far too vividly. Once again the lights were turned off and partners ushered out. But this time the ward stayed noisy. In the bed next to me another mum talked loudly on her phone, her TV blaring. She was told to keep it down but paid no attention. The bed opposite was briefly free until a new occupant arrived, her baby had just been born by emergency C section and her shocked and exhausted expression mirrored my own. As she was brought in I was sitting sideways on my bed, half naked, trying desperately to get a decent feed into my uninterested baby. I remember the look of horror on the face of the new woman's partner when he saw me. One of the midwives noisily changed the bed sheets, clanking the sinks and bins right next to me. I could feel again by now and the pain was growing. I pressed the call button to ask for some pain relief but no one came. Later I tried again, to get someone to help me lift my baby so I could feed her but again no one came.

Eventually the adults on the ward grew quieter just as the babies grew louder. I managed to flag down some pain relief but it wasn't enough and eventually, reluctantly, I was given a morphine tablet. I don't know if it was that or just the shear exhaustion but suddenly I began to hallucinate. At first it was just a little movement in the corner of my eye, down on the floor near the door - a mouse? Surely there wouldn't be mice running around the ward? If nothing else it was spotlessly clean. Then slowly the creature took the form not of a mouse but a moose, a cartoon moose that I used to draw at school. I knew it wasn't real but that only made it all the more terrifying, was I loosing my mind now? Would I soon be the "crazy lady" pacing the ward?

Still my baby wouldn't feed. For two days I been told this was terrible, or absolutely fine.  That there was something wrong with her mouth or she just needed a rest. But I needed to feed her, I had to make her ok and do something right for her, but she just wouldn't, what was I doing wrong? I wanted help but couldn't ask for it, no one seemed interested, every bit of advice I'd had contradicted the last and besides, I really shouldn't make a nuisance of myself.

Eventually it all became too much and I allowed the tears come. But it wasn't the quiet restrained little weep I had expected. It was the gulping, sobbing, unstoppable cry of a small child, I knew everyone could hear me but once I had started I couldn't haul back any control. After a while one of the midwives came over and asked what was wrong. For a moment I thought she would help me, that she would do something, so my baby would feed and I could sleep. Or she would just just tell me that yes, what I'd been through was horrible and I had every right to feel shocked and upset by it. But no. She told me sharply that I must stop crying and making a fuss or I would spoil my milk and not be able to feed my baby at all.

Then she left.

I should have called her supervisor, I should have complained and asked for help. But I didn't. Instead I listened as the supervisor (who I think was informed of the incident by another of the mums) and the midwife argued about her behavior in the corridor outside. The midwife then stomped off leaving the rest of the staff chatting about last night's TV. The supervisor did briefly come over to check I was ok but didn't mention the incident. Neither did I, I knew better than to ask for help now.

Not long after that the baby screaming really kicked off, my own alternating with one of the others in the room so that it was a constant din. I had to get out of there, I staggered to the desk and asked if there was anywhere I could go to be alone with my baby and away from the noise. Someone waved in the direction of the ward lounge, but it had dazzling automatic lights that left me feeling exposed so I asked if there was anywhere else and was pointed down the corridor to to a little room used for expressing milk.

I spent the rest of the night in that small, beige, rectangular room. There were two big machines and a plastic chair. MissE slept on and off in her crib or in my arms, though I was scared I might finally fall asleep and then drop her. Mostly I sat on the plastic chair, alone in the dark, checking off the minutes and hours on my phone until morning. When I thought it would be getting light outside I went back to my bed. No one checked on me, no one noticed I'd been gone for hours.

All I knew now was that I needed to leave. Yes I had had major surgery and my baby wasn't feeding well, but there was no way either of us could recover there and I doubted my body or mind would hold out for another night. I lay on display in my bed as the doctors and midwives did their morning ward round, discussing me as if I wasn't there, ignoring my attempts to join in the conversation about my body and it's failings.

It took hours and a lot of nagging but eventually, against the advice of the medical staff, I left. Shuffling painfully down the corridor, not fast enough to get to the room where my baby was having her first checks, but I made it out, using our new pram as a walking aid.

It was Thursday afternoon, I'd slept for a total of one hour since the previous Saturday night. I had been through an exhausting labour and emergency surgery, followed by two nights awake and afraid. I felt broken in every way and now, I had to go out and become a mother.


* I don't use the phrase "crazy lady" lightly, and I certainly hope it doesn't cause anyone any offense, it is just the best way I can think of to describe my perception of her at the time.

Tuesday, 2 May 2017

37 Weeks Pregnant And A Little In Denial

I've been pretty absent from the blog for a while for a combination of reasons. Some of these were simply practical. We've just finished a building project in our house, it's great but has meant every single room was in chaos. Combine sorting that out with two kids, a job and needing to go to bed at 8pm every night as I'm so tired and nothing much else has got a look in.

I think there may be another reason though, if I'm honest I've been a little in denial about this whole baby thing. Now I've passed the 37 week mark I should probably try to get over that.

When we started trying for number three, I'd expected to get pregnant very quickly as I had done with both MissE and MissM. But the months dragged on and I was beginning to resign myself to it not happening. Then, almost a year ago I found out I was finally pregnant only to have that excitement crushed by a miscarriage that dragged on for weeks.

When I got those two little lines again, only six weeks after the previous pregnancy was finally, surgically, ended. I didn't dare celebrate. This time an early scan shouted out good news. The little flicker of a forming heart appearing on the screen as soon as the ultrasound wand was placed on my belly. No searching around in a black void, no uncomfortable internal ultrasound. The twelve week scan showed everything to be just as it should be too but, unlike my first two pregnancies, I didn't feel like putting up a facebook post or writing about it all on here. It still felt too fragile, too risky.

We told close family and, because I work in a biohazard lab, my manager and health and safety team. But I held off spreading the news more widely until after the 20 week scan, by which point people would probably have guessed from looking at me anyway. As far as my poor abdominals are concerned, resistance is now futile.

Even now, I'm finding it hard to believe that I am full term pregnant, everything is going well and the C section is booked in less than two weeks from today. I've been pregnant for most of the last year, with two almost back to back first trimesters. Being pregnant is now my normal state, So it's strange that it will be ending so definitely and so soon.

But of course it will and today is the first time I have sat down with a cup of tea, no kids, no work and no massive to do list. I'm finding it hard to take on all the advice to relax but I probably should. It just took me almost forty minutes to walk a little over a mile and I'm waking up several times each night with the all too familiar hip pain I remember from before MissE and MissM were born. I should probably be making a concerted effort to get over that denial.

But then, although it has taken a long time to get this far, It's been even longer since I had an actual newborn to care for. MissM is almost four and half. Somewhere in the depths of my patchy memory I seem to think it's quite hard work, but maybe I'm just misremembering that.

I've done it all twice before. This baby is going to sleep and feed perfectly.

So it'll be easy this time right?


(No, it's not just a river in Egypt)


Monday, 6 March 2017

Thinking About Birth, Third Time Around

I've been awaiting the invention of fetal teleportation for more than seven years now. I mean seriously world, I can instantly access all of human knowledge, every pop song ever recorded and eleventy zillion cat videos all from this slab of metal on my lap. But when it comes to the seemingly minor task of moving a baby a few centimeters from the inside of my abdomen to the outside I have only two options, and I'm not a big fan of either.

But the baby is there (and making it's presence felt through the medium of enthusiastic capoeira as far as I can tell) so those crucial centimeters must be traversed somehow and THAT decision has to made again.

So here's a bit of a catch up, or a compare and contrast if you like, from my currently lofty view of hindsight and denial:

Birth thoughts, baby 1:

I will have a natural birth, with no drugs and no interventions. Unless it gets really really bad but seriously how likely is that right? I'm young, I'm healthy I'm six foot tall! I've done yoga class AND NCT AND hypnobirthing, I've totally got this. I'm so not one of those people who wimps out cause it hurts a bit and ends up with a C section or something.

Birth thoughts, baby 2:

So, that was horrific.

I don't want another C section. I don't want another long, long labour. I don't want to have to recover from both those things, at the same time, while also trying to look after a baby and a toddler. How the hell does that even work? Why the hell has the teleportation thing not happened yet? Can I just be put under general now and woken up with the baby is two?

I should have a VBAC and prove I can do it after all. But what are the odds it'll work? WHY ARE THERE NO GOOD STATS ON THIS? What if it doesn't work and it's all like last time, or worse than last time? The only way to avoid an emergency C section is to have a planned one right? Ok, Deep Breath.

Birth thoughts, baby 3:

This time THAT decision started out harder but ended up very straightforward. MissM's planned C section was a wonderful experience compared to the emergency finale to MissE's birth. It was both physically and psychologically healing, sorting out a lot of the scar tissue and adhesions that had left me weak and doubled over for my earliest weeks of motherhood first time around and leaving me, not just upright but able to actually enjoy having a new baby. I hadn't really thought that was possible for me.

But it wasn't easy. The recovery still hurt like hell and I spent several months fist clenchingly frustrated by my own lack of exercise but utterly physically exhausted if I did almost anything. I looked on in awe and envy as other mums were out in the park with their toddlers and babies only days, or weeks after the birth.

So, for a while I was tempted to give that whole natural, or at least vaginal, birth thing another go.

But then I had my first obstetricians appointment.

Right up front here this is not a story about a Doctor trying to scare a mum into a medical birth. When explained my thoughts this time the first thing the doctor did was say that they would absolutely support me to have a vaginal birth. But, there was a but.

It seems that, in addition to the known repairs I'd had last time, the area around the scar in my womb was very thin. The surgeon had only been able to put in one layer of stitches, rather than the two that is normal. So the resultant scar, the one that will have to stand up to months of pregnancy and hours, perhaps days, of labour is a bit flimsy. There is a risk that whole thing could come apart putting both me and the baby at considerable risk or, at the very least, resulting in major blood loss and very rapid surgery.

Of course it would probably all be fine and even if it wasn't I'd be in a bloody awesome hospital that could probably cope with it.

But it's an odd situation, there are, again, no good stats so all I have is those probablys and I've never been a big fan of probably.

So the decision became very easy, even though the doctor insisted they would still support a vaginal birth if I wanted.  I don't want to be worrying about the what if's of labour for the rest of this pregnancy, I don't want to be in labour, attached to monitors, unable to move and in constant fear of what the next contraction could bring. Even if it was all fine in the end and all that could buy me the easier recovery I'd love.

My last pregnancy ended at ten weeks with nothing to show for it put a few more pounds around my waist and a pile of anxiety held over for this time. So I'll have another planned C section, I'll put up with the pain and the immobility and, no doubt, the judgement. But, hopefully, I'll bring this baby home safe with me in a fit(ish) state to care for it. I'll never have a natural birth but, where once I would have grieved for that, now I find I'm actually ok with it. I'm in control of my body and my choices and I'm very grateful for that.

I'd still prefer the teleport though, seriously, she cannae take any more.


Friday, 20 January 2017

I will March With My Daughter

I will march with my daughter.
Because when I hold her hand, it's not so small as it used to be
and I can't hold it forever.

I will march with my daughter.
Because she can go to school and feed her fizzing mind
while so many can't, because they happen to be girls.

I will march with my daughter.
Because someday soon men will shout judgement on her body
and she will learn to ignore, placate, walk faster.
Pretend not to notice, "fucking bitch"

I will march with my daughter.
Because she may want to drink and dance with her friends one day. Just dance,
Not shrug and accept that there are prices for fun if you're female.

I will march with my daughter.
Because one day she may fall in love, and it shouldn't matter who that person is.
Only that she need never fear them.

I will march with my daughter.
Because she should do any job she chooses and works for, for the same money, for the same effort, as any man.
And not be passed over for a theoretical pregnancy.

I will march with my daughter.
Because she, and all women, must be able to choose when they become mothers,
and if.

I will march with my daughter.
Because one day she will be a middle aged woman, an old woman,
and the world shouldn't force her to fade.

I will march with my daughter.
For all the daughters, who's lives are changed or shaped or taken, by family and strangers, governments and traditions.
By those who do it just because they know they can.

I will march with my daughter.
Because she is seven years old and has no idea what worries her mother.
But her little hand is getting bigger.

I will march with my daughter.
Because she is seven years old and believes she is the equal of anyone.
I will march with my daughter because she is right.


This was written on my commute yesterday, tomorrow me and MissE will join the Women's March in London.

Monday, 9 January 2017

The Real Magic Of Pregnancy

I heard something wonderful last week. It came from a pregnancy* exercise teacher at a class I had just joined:

"This exercise might be good for the birth, I mean *knowing laugh* it won't stop it hurting of course, but it might be useful"

It seems like a pretty minor and obvious statement but it was actually a bit of a surprise. My previous forays into antenatal exercise classes (mainly yoga) have come with far greater promises: A gentle twist of my neck would nourish my immune system, lying down would put me in touch with the vibrations of the earth (this in a second floor studio btw) and breathing like Darth Vader would open my pelvis and and provide an easy birth, one where I'd barely notice any pain.

The problem is all of that is total BS. I love yoga. I love how at the end of a session I feel warm, relaxed and strong. I love that my usually unceasingly busy mind is stilled, just for a while.

That is the real magic, that is enough. I don't need to imbue the actions with miraculous powers of healing or pseudo-spiritual beliefs. It makes me feel good, it stretches out a little space for my already squashed lungs and if I can get through a class without humiliating myself by falling on my nose or farting then I feel pretty pleased with myself.

So hearing that simple statement that strength and flexibility are helpful for a physically arduous process like labour, but that they won't magically prevent the pain, was a relief. It went a long way towards loosening the little knot of apprehension I always get when starting this kind of class and wondering just how much nonsense I will have to accept into the bargain.

Of course yoga classes aren't the only part of pregnancy where this need to add extra magic exists.

There is a growing sea of products, services and philosophies that claim to make our pregnancies and births that bit more special. They often invoke empowerment, and goddesses, promising to make pregnancy and birth wondrous, easy and natural. Like there is some great, universal, secret truth to all this. That we somehow lost sight of when we started going to supermarkets and watching TV.

NHS resources are stretched so thin that women often have little time to ask questions. Let alone build relationships and actually feel cared for at probably the most important and worrying period of their lives to date. So it's no wonder many of us look elsewhere to fill the gaps in those long months. If you have the cash there are no end of people willing to take it off you help you. Some claim no more than to make you feel nice and relaxed, others promise the world with little more than anecdote and belief to back up those claims and price tags to exclude most.

At times these philosophers and practitioners stray into telling women to avoid conventional medical care all together. In the false belief that we are somehow the perfect end point of creation or evolution. That our bodies will all instinctively grow healthy babies, know when to give birth to them and do so with ease. If only we believe, do the class, buy the product and don't mess with nature's great plan.

But nature, as I've said so many times on here, doesn't work like that. She is complicated, messy, glorious and she doesn't give a damn about any single individual. But she is also far more wondrous and magical in her imperfections than in any of the beliefs to the contrary.

The fact that I am sitting here at all is a miracle of nature.

Over 1.5 billion years ago one little cell engulfed a different type of little cell. For the first (and last) time in history, those particular types of cell survived and formed a particular type of symbiotic relationship from which descended all multi cellular life on earth. The simple slimy sea creatures, the fish that crawled onto land, the first little furry things that hid from mighty dinosaurs and every monkey, ape and human that came before us. And the vast, vast, majority of all those lives ended before they could reproduce. We, all of us, are life's unlikely winners who beat ridiculous odds over and over again for millennia. The existence of the most ordinary, boring person on this earth is utterly wondrous.

That I have a baby growing in my belly now is just as amazing. The chances of any given sperm or egg making it to fertilization are tiny. But then there are the trials of genetic recombination, implantation, hormones and myriad other potential pitfalls. Yet somehow this little creature has jumped every hurdle it has so far encountered, without me doing anything other than take some vitamin pills to be on the safe side.

Her/His birth will be a wonder too. But not because I will channel my inner goddess or breath the baby out in a state of empowered, pain free bliss (or while doing that Darth Vader impression). If that works for you go for it, but I have other magic to conjure:

Nature gives different gifts to all her creations, she gave humans incredible brains. They let us thrive in environments that seem ridiculous for such clawless, furless, vulnerable creatures. The price for our brains is that childbirth isn't always easy or even survivable. Yet we amazing humans haven't just put up with that. We've used our astonishing gift to find ways to help nature or perhaps to cheat her. Those amazing, nature given brains decided to get women to help each other give birth, they invented tools to help labouring women into better positions or ease out a baby that had become stuck. They created drugs to ease pain and fight infections and eventually pieced together all the required components of complex surgery that could save the lives of women whose baby's own, brain filled, heads were just too big.

My first baby's head was one of those that was just too big, a C section saved us and will (if all goes to plan) bring this one into the world. I'm incredible lucky to be alive and to have that option.

Nature is full of wonder and full of flaws, she is complex way beyond our current imagining. Yet we can work with her, try to understand her and so do astonishing things ourselves.

I don't need to guild that wonder with extra magic. There is a tiny heart beating in my womb, tiny limbs kicking. One of the most complex brains that has ever existed is forming and refining itself while I sit here drinking decaf tea and wittering to the internet.

I don't need this to be more special, more mystical or somehow spiritual. It is already amazing beyond anything those ideas can create. It is science, it is magic and it is enough.


* Yes I am pregnant! I was incredibly lucky after last years miscarriage to get pregnant again quite quickly and have so far made it to 21 weeks with everything seeming to be fine. I'm sure I'll have plenty more to say about that on here if only I can stay awake past the kids bedtime in order to write it down. In the mean time I'll leave you with one of the more curious images I found while looking for pictures for this post. Amazingly this is the first thing that comes up if you type "pregnancy nature" into Getty image search...

Tuesday, 6 December 2016

Caesareans May Be Altering Human Evolution. But Not Much, And I Don't Care.

According to reports on the BBC (and elsewhere) today, the number of women having C sections is causing our species to evolve bigger heads and / or smaller pelvises and so we are becoming less able to give birth without surgical help. 

The Miami Herald got particularly upset declaring: 

"C-Sections Are Increasing Because We're Messing With Evolution..."

I wrote last year about a similar idea from Obstetrician and (IMHO) slightly questionable old chap, Michael Odent. His opinion was based on, well, his opinion but these new stories actually come from a real life proper scientific journal. This month's PNAS.

So are the headlines all true this time?

Well, yes, maybe and no.

It all sounds very dramatic in the news reports, the idea that we are messing with nature and pushing evolution to make us ever more dependent on modern technology. It has a grippingly dystopian feel. It is true that women and babies now survive where once their respective small pelvises or large heads would have fatally removed them from our gene pool. I am one of those women. My genes only made it to my daughter and to her younger sister because cold hard modern medicine overruled nature.

So it is possible that children like mine will go on to need surgical births themselves, where in the past they would simply have never lived to give birth at all. With a few more women like us around the human population as a whole may need more C sections in future. We may evolve to, on average, do birth a little bit different.

But that's not in any way special.

Almost everything we do that keeps babies alive impacts on our evolution. Genes that confer all manner of slight disadvantage can make it from generation to generation because everything from clean water and plentiful food to vaccinations and childhood heart surgery mean that children who would once have died are living long enough to keep those genes in circulation. There may be a few more people around with heart conditions, or a tendency to get food poisoning but we assume that if we can treat those problems now, then we will continue to do so, and probably better, in the future. 

The need for a surgical birth is no different, and it is also a very very small change. 

Read on a bit beyond the scary sounding headlines and the photos of distressed looking mothers and it becomes clear that we are talking about a fairly small number births. The study estimates that the number of C sections for obstruction (where the baby's head is too big to fit through the mother's pelvis) was around 30 per 1000 births in the 1960's and has now "evolved" to be roughly 36 per 1000. A tiny proportion of the total C section rate of around 250-300 or more per 1000 in many developed countries. The evolutionary effect of women like me surviving childbirth isn't a big driver in the increase in CS rates, there are plenty of other culprits to look for there.

Messin' with the gene pool

But even that small influence may be overstated by the research. Genetics isn't as simple as - you get what your mum had. There are multiple genes and environmental factors at work. Dad's also have something to do with it. A small headed woman, with a normal pelvis, and a mother who popped babies out with no problems, could find herself in need of a C section because her baby's father passed on a whole bunch of big head genes (looking at no one in particular Mr SB...). Probably more significantly, a lot of women with perfectly average genes produce overly large babies because of factors that are becoming far more common such obesity or gestational diabetes or just through plain old chance. 

Big babies are usually an advantage. Evolution doesn't make perfect finished products, it goes for the best possible compromise and big heads with their big brains are so useful to the species as a whole that nature is prepared to accept a few individual casualties where things go too far. So even without any C section caused evolution, big babies will continue to happen.

Even very big babies can often be born vaginally if they are in the right position. Heads squish and pelvises stretch. My first child was a stonking 9lb 10oz (about 4.5kg) but plenty of people have babies that big. Perhaps my pelvis was too small for her or, more likely, the problem was her difficult position. Babies heads aren't perfect spheres and pelvises aren't round holes, try to stick one through the other the wrong way around and it just doesn't work (See this blog about the study for a lot more info on that). 

So, as is so often the case, what we have here is some academically interesting work about something that isn't very significant for the vast majority of people but which has, by virtue of being about women's bodies, been built into a futuristic horror story. Something to both chastise us for our supposed choices and terrify us about our most powerful, normal, female act. 

There may be a slight evolutionary shift in how we give birth because of the availability of a safe way to save some of us from death in childbirth but it won't spell the end for normal human reproduction. I for one will be sorry if I have passed on genes to my daughters that will make it harder for them should they ever choose to become mothers. I hope the many other factors at work will spare them surgery. I would myself have preferred normal births to the blood loss and grueling recoveries of my c sections. But without those c sections I would not be here, my daughters would not be here and if the price of their lives, and all the other babies like them, is yet another tiny tweek in our constantly tweeked gene pool then tweek away I don't care, bring on the evolution.