Wednesday, 30 April 2014

BiB Awards 2014 - Short List Excitement!

I got some very exciting and unexpected news today: This blog has made it to the short list for the Health category of the BiB Awards 2014!


Thank you so much to everyone who nominated me, I really didn't expect to make the list! Even if I don't get any further I'm delighted to have had this opportunity to get my blog noticed in the parent blogging world and to hopefully raise a bit more awareness about the dreadful barrage of pseudoscience and nonsense that is hurled at us parents: Why is a so called health magazine peddling cruel and inaccurate scare stories at vulnerable pregnant women? Why are we still having the vaccine debate? Why are we not just given accurate information and allowed to make informed decisions? Why are we often the only group it's still ok to single out as stupid? Oh yeah and why on earth are people trying to sell us magnets to shove in our knickers? (If you're looking through the short list and wondering what this blog is about, those links should give you an idea).

I Need Your Help!

But, I still need your help. The next stage is to whittle the short list down the the finalists. This is done mostly on a public vote, so please please vote for me again by clicking here or on the BiB badge above and filling in the form (please only do it once though, multiple votes don't count). There are some amazing blogs in my category and some of them are much bigger names in the blogging world than me so I need all the help I can get. If you like the sort of things I say please also share a link on social media.

Right, begging letter over, I'm off for a celebratory glass of wine to be followed swiftly by an early night, such is the rock and roll lifestyle of a prize nominated blogger!

PS. Thank you again to everyone who took the time to nominate me, it really means a lot.

Friday, 25 April 2014

Working Mum Images

This morning I was a proper working mum. You know the type, they look like this:

Skinny decaf soya latte in one hand, kid in the other while also managing to take a urgent phone call and look slightly stressed yet smartly dressed and immaculately groomed.

For a moment I thought - "that's what I look like!". Then I realised what I actually looked like:

There is no picture of me.

 It wasn't an artisan coffee, it was a cup of builders tea, most of which was pouring over my hand as I ran from the school gates and up the stairs to the train platform, fumbling with my oyster card. Oh and the urgent call wasn't to close a million pound deal or confirm my latest book tour. I was desperately trying to reserve a toy at the Disney store, having promised it to MissE as a reward before discovering it was out of stock everywhere and selling for a bleeding fortune on Ebay. Oh and I was of course lightly daubed in weatabix, and dressed in knackered leggings and a jacket which was both inappropriate for the ongoing downpour, and missing several buttons. As for the grooming; if a well meaning passer-by had seen only my hair, they could be forgiven for calling the RSPCA to rescue the abused poodle.

No, really, there is no picture of me here.

Instead, I shall try to continue in my deluded belief that this is what I look like...

 This mother model had time for full hair and make up, but didn't spot that her someone else's kid had covered her in post its.

This Mum still makes time to be pleased about all the interesting things her daughter has been looking up on the internet.

Hold on, is she pleased?

Er, no, no she isn't. But she still has nice hair and make up and a really fancy coffee machine, so it's all good.

This woman is so awesome at the working Mum thing that she doesn't even drink coffee instead she coordinates everyone's outfits with their freshly squeezed juice of the day

 The first women just realised that that random kid put super glue on both sides of that phone and she now has to spend all day with her face stuck to her shoulder.

"If you touch the keyboard one more time Isabella-lullabelle, Mummy will have to go on another of her special holidays and it'll be no more organic Quinoa treats for you"

Dad's can join in too. This power couple start the day with a rousing chorus of YMCA

This is exactly how I look when I'm blogging BTW

Oh no this is what I look like *snorts* like any Mum has hair like that! That is the hair you have when you are pregnant. When the baby arrives you tie it in a greasy ponytail for six months then give up and have it cut short.

Still stuck poor love.


Friday, 4 April 2014

Birth Choice, Evidence and Squishy Biology


***Warning: The Following Post Contains Scenes of Gratuitous Statistics***

I like scientific evidence. I think that much will have become clear to any regular readers that I have. But what may also have become apparent is that it's not simple. Experiments and studies rarely give us definite black or white answers that apply to everyone. Biology is full of squishy things that just don't work like that.

I read a really interesting blog post recently by midwife Sheena Byrom who is fighting to improve maternity services and calling for better use of evidence in making decisions. I am all for that, but I don't agree with everything she said in her blog. So, rather than continue high-jacking her comments section, I decided to write my own post here.

The evidence in question is the Birth Place Study. This looked at a large group of pregnant women and where they planned to give birth (hospital, home, birthing centre). It then compared various outcomes of those births. The headline finding was good news - giving birth in the UK is very safe, wherever the mother chooses. But there is a slightly increased risk of harm to the baby for first time mums selecting home births.

Note: The difference was only seen in low risk first time mothers. Therefore this post deals exclusively  with this group. In addition, it was a UK study so the findings may not be applicable to other countries.

The Birth Place Study showed that for every 1000 planned home births, there would be 4 additional "primary outcomes" (I'll explain primary outcomes more in a minute, but they are a collection of bad things that can happen to a baby during birth). Byrom argues that this is a "small number", but that women are often only told that there in an "increased risk" and not given that number. She is also concerned that women aren't informed of the increased likelihood of interventions for those giving birth in hospital (such as instrumental delivery, emergency C-section etc) Therefore, she concludes that many women are unfairly scared away from out of hospital birth, and maternity services should be working to enable or perhaps encourage, far more first time mums to give birth out of hospital, to avoid all these "unnecessary" interventions.

It's a perfectly valid interpretation of the evidence but it's not the only one. Many of these "primary outcomes" are very serious. Therefore you could also argue that avoiding them is so important that the risk of extra interventions, although they are unpleasant and sometimes dangerous themselves, is a price worth paying.

So should we be working to get all first time Mums having home births or hospital? What is worse - a small risk of a major outcome for the baby or a larger risk of an intervention for the mother which could also have negative consequences? Can even a large and well conducted study answer this question?

What we need to know is - how much does home birth increase the risk of "primary outcomes", how much does hospital birth increase the risk of interventions and just how bad are all these outcomes and interventions anyway?

The information is all out there, but I've not yet seen it presented clearly, all in one place.

The main BMJ paper of the Birth Place study only gives the overall intervention rate for all mothers, but with a bit of digging I found the  Which? - Birth choice website  which gives the numbers for first time births only. This data comes from the online supplement of the BMJ paper (look for appendix 8.6 on page 70).*

Here, as simply as I can manage, is the data from the Birth Place Study for first time, low risk births. I have converted all the data into the how many per 1000 format:

Evaluating the risk - How likely is it that something negative will happen?

Harm to the baby

For 1000 mothers all choosing to give birth in the same place, this is how many of their babies would have one or more of the "Primary Outcomes" studied:

All low risk first time mums

Low risk first time mums with no complicating conditions at the start of labour

Risk of interventions 

For 1000 first time mothers all choosing to give birth in the same place, this is how many would have each kind of intervention:

Ventouse delivery
Forceps delivery
Emergency C-section
Syntocinon Augmentation*
Epidural or spinal anaesthetic

*Syntocinon is a drip of artificial oxytocin, usually given to speed up labour

Total number of births that would NOT be considered "normal" (Normal birth is defined as birth without induction, forceps, ventouse, caesarean, episiotomy or epidural, spinal or general anaesthetic.)

Hospital 540 / 1000
Home 310 / 1000

How Bad Are those negative outcomes?

For the baby

The study looked at how many babies suffered what they called "primary outcomes". I've listed the outcomes they included in this below. The number in brackets is what percentage of the total number of primary outcomes each represents, eg. 30% of primary outcomes were meconium aspiration syndrome.

Still births and Neonatal deaths (13%)
Neonatal encephalopathy - disturbed brain function, usually due to lack of oxygen  (46%)
Meconium aspiration syndrome -inhalation of stool into the lungs  (30%)
Brachial plexus injury -damage to nerves that take signals from the spine to shoulders/arms/hands (8%)
Fractures to the humerus or clavicle -upper arm and collar bone (4%).

The small number of deaths are, undoubtedly, a tragedy. Any damage to the lungs, nerves or brain are very serious outcomes, although they may not always result in life long problems. Bone fractures, are very unpleasant but probably won't cause lasting issues.  So there is a considerable variation in how bad the outcomes actually are within this group. Thankfully they are all very rare, but this means the study authors can't give the figure for each individual outcome for each group. There just wouldn't be enough events to get a reliable number.

For the Mother

At the very least, all the interventions listed above can be unpleasant. They can cause increased pain or limit a woman's mobility during labour. Some can increase the likelihood of further interventions, for example, epidurals are associated with more instrumental (forceps and ventouse) deliveries. In rare cases there can be serious and long term effects. To try to stop this post getting too long I won't go into the pros and cons of each intervention but this information should be made available to women trying to make this decision.

It is also worth noting that not all women will want to avoid all the interventions above. For example, some may choose hospital birth specifically so that they have access to an epidural for pain relief.

Transfer Rates

This study grouped women by where they planned to give birth, not where the baby was was actually delivered. For first time mothers, 45% of those who wanted a home birth ended up being transferred to hospital. This is a very large number so women considering a home birth should also be aware of it.

Conclusion   Stuff From My Head

I'm really not in the business of worrying anyone here, the biggest finding of this study was that women in the UK don't need to fear giving birth.

Clearly, the increased risk associated with home birth for a first time mother is low. The risk of having some kind of intervention is much higher. This is true wherever a woman plans to give birth, but especially for planned hospital births.

Personally I was actually surprised that the increase in interventions wasn't even higher in hospital. I've often heard advocates of home birth state that unnecessary interventions are very common in hospital so I had assumed the difference would be many fold. But from this data, the biggest increase is a doubling in the likelihood of a ventouse delivery. The other interventions are slightly less than double, which is about the same as the increased risk of primary outcomes for home birth. That said, these are relative risks. The absolute risk of ventouse delivery increases from 60/1000 to 120/1000 for home and hospital respectively. Primary outcomes are rarer, increasing from 5.3/1000 for hospital to 9.3/1000 for home.

Having seen all these figures, I still don't think there is a clear cut correct answer. Once again, biology is squishy and what is right for one person may not be for the next. Overall the risk of serious, long term harm is very low wherever a woman chooses to give birth. So it comes down to each woman's interpretation of the remaining risks. This is personal and complex, depending on her individual history, her specific situation, and to a great extent her beliefs and emotions. No one can or should answer this question for her.


So I wholeheartedly agree with Byrom that women should be given the information they need to make informed choices and that evidence should be used to shape maternity services. But I worry that the only people advocating this are those who want to see more home births or "normal" births. If there are women who want these options and, against the evidence, are being denied them then I absolutely support that fight. However, if the campaign is truly about maternal choice and using evidence, then shouldn't these advocates also be cheering on those women who feel safest and most comfortable giving birth in hospital? Who make a rational decision that they want an epidural, or even a C-section? With modern techniques these options could also be considered low risk and I don't believe that there is anything inherently wrong in women wanting to make use of modern science and medicine.

Also, rather than just giving up on hospital birth and heading home to avoid the interventions, shouldn't we be asking why there are more interventions in hospital? How many are genuinely unwanted or unnecessary and what can be done about that?

*09/04/14 - Correction. I originally stated that the BMJ paper only gave the intervention risks for all women and not for first time mothers only. Thank you to Jennifer Hollowell from the Birth Place Study team who pointed out that this information was given in the supplemental online material. I've amended the relevant paragraph accordingly.


A Third Way
What I haven't covered here is the third choice in the birth place study, midwife led units. These can either be stand alone centres or alongside obstetric units and, from the Birth Place Study,  seem to offer the best of both worlds. The primary outcome levels are the same as for hospitals but the intervention rates are more similar to home births. Sadly it's not an option available to many women. I'd love to see more of these units but I suspect health authorities are unwilling to spend money on setting them up when the loudest calls are for home birth, which requires no major capital outlay.

Wednesday, 2 April 2014

Vote SouthwarkBelle

So, do you like the new look?

I live in a constant state of doubt with this blog. Does anyone other than me actually care about the things I rant about? Why am I spending so much time on this when time is such a rare commodity these days? Sometimes I consider jacking it in and getting a few more early nights instead.

These doubts are even stronger at this time of year. This is when nominations are happening for some of the parent blogging awards. Every year I look at them and every year I have decide not to enter. There has never been a category that I seemed to fit in. There are some amazing blogs out there and I certainly wouldn't consider myself to be Best Blog or Best Writer material, but the specialist categories have always been for things like food, crafts and fashion. All things I like (especially the food!), but not things I write about.

So why am I still here?

Because, just sometimes, some small but lovely things happen.

Some complete strangers read some things I've written and make the effort to send me a tweet, saying they'd enjoyed it and they agree with me.

A friend I've not heard from in a while, unasked, tells me she enjoys my blog.

One of the blogging awards gets some new categories.

So here I am with a whole new look and a resolution to continue. Thank you so much to everyone who has taken the time to read, comment, tweet, share, like etc. etc. over the years. Can I now ask you a favour?

Vote for me!



I would be so grateful if you could vote for this blog in the 2014 Brilliance in Blogging awards. Just click on the picture above and fill in the form, it'll only take a couple of minutes. I'm particularly looking at the Health and Commentary & Campaigns categories, but you can vote in as many as you like. 

This blog doesn't really fit in with the parent blogging world a lot of the time, but I am delighted to see the new categories the BiBs have introduced this year. It just goes to show how diverse the interests of today's parents are. Even if this goes nowhere and I don't even make the shortlist, it would be great to promote the blog a little bit more and to get something a little bit different entered into the awards. Maybe even convince a few more people that we parents can love cooking, crafting, clothes  and a good dose of sciencey stuff.

Thank you!