Sunday, 30 October 2011

The Scientific Manual for Mums

It's a long running joke; "babies! They don't come with a manual you know!". Oh if only that were true. A few seconds on google and you can find literally millions of books, articles, websites etc etc all proffering instructions from child rearing "experts" most claiming that their methods are backed up by "scientific evidence".

But here's the thing - the presentation of this "scientific evidence" by both the "experts" and the media can be deeply, deeply flawed.

There are countless examples of this, but  here is a recent one from the Telegraph.  If you can't be bothered to read it yourself here's a summary:

 A paediatrician says that babies should sleep in the same bed and in close contact with their mothers (co-sleeping) until they are three years old. Not doing so will cause stress to the child's heart, the child will sleep poorly, have more difficulty bonding with it's mother, and their brain development may be damaged, leading to behavioural problems later in life. The article also acknowledges that this goes against the prevailing medical view that co-sleeping should be discouraged because it may increase the risk of cot death, but this is countered by the paediatrician who says that these deaths are due to "toxic chemicals, cigarettes, alcohol..."etc. 

So, a balanced article on a vital new scientific discovery right?

I just want to say at this point that this post isn't about my opinions on co-sleeping, or people who choose to practice it or not. This is me with my scientist hat ( or should that be coat?) on getting annoyed at some dodgy journalism.

With that in mind the first thing that worries me about this article is - where are the references? You'd expect a article on a scientific discovery to tell you where the information was published, that's how science is supposed to work.* Here the only other publication mentioned is the Daily Mail.

So I did a quick search on PubMed, (a website that allows you to search for scientific/medical publications). I'll be honest I was a bit surprised when a recent paper by the paediatrician concerned did actually turn up. But I was even more surprised when I read the abstract. To summarise the summary: 

16 two day old infants (still in hospital) were studied for one hour while they slept on their mothers and for one hour while they slept in a crib. The babies behaviour and the variation in their heart rates was observed as they slept. Most of the babies slept better when on their mothers.

This is the only paper this doctor seems to have published in the last seven years** so we have to assume that this is the only validated evidence for the article.


So how do we get from 16 two day old neonates having steadier heart rates for a hour when with their mothers than for an hour in a crib, to behavioural problems in teenagers who didn't sleep with their Mums as toddlers?

I have no idea.

There are a huge number of flaws that could be picked on at this point, but for the sake of brevity I'll limit myself to one of them: Anyone who has cared for a new born baby will know that they are only calm and happy when being held, I'm actually amazed he got 16 of them to sleep in a crib at all! 48 hours ago they were curled in a tight warm ball inside Mum, now they are in a little plastic tank in a fluorescently lit hospital ward. Of course they are happier cuddling Mummy. But to assume from this that all toddlers would behave the same is far fetched to say the least, so why then stop at 3? Perhaps we could have prevented all the recent riots if only teenagers snuggled up to Mum at night? 

Of course the actual published paper makes none of the claims in the Telegraph article, or indeed in the Daily Mail article it was taken from , if it did it would never have been accepted for publication, it merely concludes that sleeping away from the mother increased variation in heart rates, that the babies didn't sleep for so long and that this may be a cause of stress. 

It is the newspaper articles that make the real consequence-heavy, evidence-light claims, while attempting to seem balanced. A similar thing happened with the now notorious MMR scare. In an attempt to seem fair, journalists gave equal space to the tiny minority who thought the vaccine was damaging and to the vast vast majority of medical professionals who thought it was safe. As a result the public, understandably, got the impression that no one really knew the truth and many opted not to vaccinate their kids as they thought the risk of side effects was greater than the risk of disease. Children died.

So, not a balanced article, or a major scientific breakthrough, but a small study of a handful of newborns and a few wildly speculative column inches. But how the heck are readers supposed to know that? We're told by a broad sheet newspaper that this is a Paediatrician, at a university, a scientific study with numbers and results. This is just one article of the many that appear in the media every week, surely the writers don't assume every reader is checking up on the references on PubMed? Why should they anyway?

As with so many parenting issues there is no clear scientific evidence to say all parents should or shouldn't co-sleep. The official advice, backed up by another study in the news just last week, is that babies should be in a cot in their parents room until they are 6 months old, but that actual co-sleeping carried an increased risk of cot death. However many parents, aware of that advice, believe that given the risks are minimal, it is more natural and beneficial to have their baby in bed with them or simply resort to it as the only way of anyone getting any sleep. Many of these parents will look to the media, websites etc, for evidence to help them make an informed decision, so it is vital that the information they find is accurate, not personal opinions masquerading as facts

Additionally, parents who choose to follow the conventional advice shouldn't be made to feel guilty about it, or worry that they are physically and emotionally damaging their children unless there is really, really REALLY good evidence.


*For the non-scientists reading this, the norm is for scientists/doctors to to conduct their experiments, then write up what they have done and send it to a scientific journal. The journal will pass it on to a number of unconnected people working in the same field who will check it over and if they think it is good enough, give it the ok for publication. Basically, anything a doctor, scientist or some bloke off the telly says they have scientific proof for, if it's not made it through this peer review process, it doesn't count. That's not to say it is definitely false, just that there is insufficient evidence to believe it at the moment. That's the great thing about science, we get to change our minds.

**One paper in seven years isn't all that impressive by the way, I'm just a techy and I published two papers while I was on maternity leave (and yeah I just put this bit in to show off).

Thursday, 20 October 2011

Conversations With My Two Year Old

Mummy: Hello Evelyn, did you have a nice nap?
Evelyn: Oh yes! I saw Dinosaurs!!!
M: oooo Did you? Where?
E: (to the tune of Wind the Bobbin Up): 
There's a Dinosaur
There's a Dinosaur
Look! Look! 
Rar Rar Rar (repeat)

There's one on the ceiling
There's one on the floor
There's one on the window
There's one on the door

E: *Proud look*
M: *falls about giggling*

I've never heard this version of the song before! She either picked it up at a music session with Granny that morning or just made it up, either way I think I prefer it to the original and it provides the perfect excuse to plan a trip to the Natural History Museum! Yay!


Tuesday, 11 October 2011

Love in a Time of Sniffles

Yesterday was one of those mornings every parent of small children has experienced many times over. You wake up heavy with tiredness and the cold that's been threatening for days. As you blearily fumble in the bedside cabinet for tissues and any drugs you can find, you say a tiny, pathetic, hopeless prayer to any god who might be bothered to listen: "please, just let her sleep late today, PLEASE". Then, inevitably, the snuffling sound of a child who is not only awake, but also joining you in the cold will come over the monitor and you'll know exactly how the rest of the day is going to pan out.

So, having forgone bounce and rhyme at the library, for fear of spreading our bugs, tooled up with cbeebies magazines and endured an entire episode of "Show Me Show Me" I managed to get a whining Evelyn up to bed for her nap. We'd not been delighting in each others company that morning she was annoyed that mummy wouldn't let her shred an entire box of tissues on the rug and I'd resorted to putting on radio 4 over lunch to have something to listen to other than my own tinnitus and her constant low level whinge. But as I held her in my arms, all bundled up in her sleeping bag, she gave me a big cuddle then looked at me and said "love you very much".


She's a wily old bird mother nature, just when you are questioning the entire concept of Human procreation, never mind the wisdom of your own involvement in it, your little one says I love you and it's the best medicine in the world.


Thursday, 6 October 2011

Myths, Legends and Caesarean Sections

or, How to Fail An NCT Class.

This article apeared on the BBC website last week, if you are Geeky enough to follow me on twitter you may have already seen me "tweeting" it.

The writer claims that antenatal classes can leave women unprepared for caesarian births and perpetuate the myths surrounding them, with the result that those who do find themselves under the knife can end up feeling guilty about it. While I doubt this is universally true, it certainly struck a chord with me.

I didn't attend any NHS antenatal classes* at our "booking in" appointment the midwife took one look at MrSB in a suit, in a deprived part of London and told us to: "join the NCT, to meet people like you." So we duly did. The basic logistics of a caesarean birth were covered, but with a distinct sense of distaste and the message that this was what would happen to you if you let those evil doctor types near you. If you were a healthy, western woman, who did her yoga and breathing exercises and stayed well away from said doctor types then there was no reason, or perhaps no excuse, for having a caesarean.

To be honest I hid my head in the sand about it and didn't seek out extra information on C-sections. I really really didn't want one and if the NCT, pregnancy yoga, hypnobirthing CDs etc. etc. all told me they'd reduce my chance of one then I was pretty much guaranteed one of those life enhancing "birth experience" thingies, right?

Now, I can appreciate that antenatal classes don't want to promote caesareans and that a natural birth is preferable for numerous reasons, but many many women end up with a C-section, so surely it is better that they are adequately prepared for it?

After my own experience, I think there is another important aspect to this that isn't covered in the article. Namely, the treatment of  women immediately after they've had an emergency caesarean. Admittedly I was rather away with some pretty ugly fairies at the time (actually a tiny moose running along the skirting board at one point), but I can't remember any of the midwives giving me a sympathetic smile and telling me it was ok I'd had to have surgery, or even giving me basic information on what it was or wasn't safe to do (it took more than a day to get someone to tell me if I could even have a shower, ich, never mind picking up the baby, driving etc. etc.). Add to that the seemingly endless stretches of night, pushing the buzzer for pain relief and being ignored and I got the impression that the postnatal ward staff thought I was, at best, an inconvenience.

Our NCT teacher was even less help. When, exactly two weeks after surgery, I agonisingly shuffled into our postnatal meetup, she asked how the birth had been, then asked to see my hands. After examining them, she hmmmed at them a bit and then implied that I probably didn't really need a C-section (answers on a postcard as to what the hand thing is about?!). Well perhaps I should forgive her ignorance, after all she hadn't actually seen the burly surgeon, legs braced against the operating table, applying his full body weight to the sink plunger on MissE's head in an unsuccessful attempt to get her out, but this, added to her take on all medical interventions in our previous classes, left me with the distinct impression that I was considered a failure.

Ok, mums have a bit of a reputation for feeling guilty about, well pretty much everything, but surely the way in which we became a mother shouldn't be one of those things and those who are supposed to inform and care for us both before and after that precious child arrives shouldn't treat those with some of the worst experiences like they've let everyone down.

 *Actually I did go to a talk on pain relief given by a terribly cute anesthetist; shame he wasn't on duty when the time came, that may have brightened the situation considerably ;o)

PS. Off soapbox now, promise to get back to cute pictures soon!

Monday, 3 October 2011

When We Were Two

It doesn't seem possible that another year has gone by already, and yet one year old Evelyn seems very, very long ago. This time last year she couldn't walk and could only manage a few words, most of them duck related, last week, after nursery, I sat down and had a conversation with her. Ok it wasn't Frost-Nixon but I asked her what she had done that day and she told me, one year old Evelyn would probably just have said "quack!"

After last years trip to a city farm for her birthday we decided to go one up on that this year and take her for her first trip to London Zoo. So of course, it being August in England, the heavens sent us a biblical deluge, I wouldn't have been surprised to see Noah with a clipboard just past the ticket line but on the plus side this meant the zoo was pretty quiet and the more sensible animals were taking shelter in the easy to view indoor areas. Que immense delight from Evelyn at seeing a Gorilla, sitting on a branch and actually eating a banana.

This excitement was only surpassed by the walk through monkey enclosure in which Evelyn screamed MONKEY! every time she saw one, getting several notes higher each time until we began to wonder if soon only the monkeys would hear her. 

After all that we gave her the traditional overdose of cake and then presents. Evelyn has now got the hang of this present thing and she greatly approves of it. I think this years favourite toy is a little tin tea set. You generally can't sit down for all that long in our house now before a little voice says "would you like a cup of tea please", hands you a tiny tin cup and waits expectantly for you to make appreciative slurping noises.
As if all that wasn't enough excitement she also had a little party the following weekend, the highlight of which was her and some of her NCT friends playing hunt the snail in our garden (to be honest it's not hard to find snails in our garden).

So that was that, Evelyn is two, can sing the happy birthday song competently and now thinks the sight of a candle should always be followed by cake and/or presents! She went around chanting "happy birthday Evelyn" to herself for weeks. Goodness knows how excited she'll be when she turns three but I'm in no rush to find out, two year old Evelyn is great fun.

A year on, but some things never change