Wednesday, 27 May 2015

Are Women Losing The Ability To Give Birth Naturally?

Or,  Has Michael Odent finally jumped the shark dolphin...*

Has something happened that is stopping women from performing the most ordinary but amazing act in nature? Well according to French surgeon and Obstetrician Michael Odent it has. But I'm not so sure...

Firstly big hat tip to Kiran Chug who has already blogged about this here, I wanted to write about this too and chip in a few of my very own opinions - I'm going to be quite ranty here I suspect.

Odent has just published a new book which is critical of modern maternity care and, it seems, modern mothers. Needless to say the Telegraph and Daily Mail are happy to share that. He believes that there are far too many births involving drugs or surgery. As a result of this, Odent says that the female of the species is loosing the ability to give birth as nature, or at least Odent, intended. I'll come back to some of the claims he's making in a minute. But first a few thoughts on the great man himself.

I first came across him when he was interviewed on BBC radio 4's Woman's Hour. At the time he was promoting the idea that men shouldn't be present at their children's birth. It would apparently interfere with the birthing process, upset everyone and ultimately lead to divorce.  Of course some men are appalling birth partners and are best kept away but others are a huge comfort and great practical help during birth. The thought of going through MissE's birth without F there is terrifying, I clung to him physically and emotionally and I don't know how I would have coped without him. So had Odent done a large and carefully controlled study to determine that actually dads made things worse? It's a pretty bold claim to make so there must be good evidence right?

nah, not so much.

As far as I can tell this is just his opinion. Oh and Odent sure has a lot of opinions. During the same interview he was talking about how safe childbirth is. He was then asked - if birth is so very safe, how come so many women and babies die in countries where there is little medical care? He just flat out denied that they do and for some reason the interviewer just moved on.

But Odent doesn't just deny suffering, he positively encourages it. He's also said that women shouldn't attempt to reduce the pain of childbirth with drugs because that pain teaches us a valuable lesson about the responsibilities of Motherhood. Which makes me wonder - I was in labour for 34 hours with a 9lb 10oz back to back baby, for some of that time I was on a drip to make the contractions stronger. It was f***ing agony. I also have a friend who's had 3 wonderful and very quick, homebirths. I got more pain - does that make me the more responsible Mum? Oh and how do Dads learn responsibility? Especially if they aren't in the delivery room for you to punch?

Odent is one of the pioneers of water birth and as such is often lauded by natural birth advocates for empowering women. But to me many of his opinions smack of old school (and he is in his 80's) patriarchal misogyny. Telling women how to give birth, releasing fathers from any responsibility and insisting that women must suffer to bring forth children. Are those really things to aspire to in 2015?

"To the woman he said, “I will surely multiply your pain in childbearing; in pain you shall bring forth children"
Genesis 3:16

And then we get to the real woo.

Odent is also on the editorial board of the deeply dubious magazine "What Doctors Don't tell You" (WDDTY). I've written about this before and in my opinion it is a horrible and dangerous publication. It advocates conspiracy theories and ignoring actual medical advice in favor of unproven or completely disproven alternative remedies. Which of course just happen to be advertised, for a price, in the magazine.

So my opinion on Odent?  I really can't trust anything he says. He makes grand proclamations based solely on his own beliefs, but uses his position and medical title to make them sound like facts. His involvement with WDDTY suggests he either fails to understand some pretty basic science or is happy to make money out of flogging dangerous nonsense (I'm really not sure which is worse).

But back to his current round of wisdom. There are a number of things that just don't make sense in the newspaper articles. He claims that an "insignificant number" of women now give birth naturally, but in the UK around 40% give birth with no drugs or interventions. That's hardly an insignificant number. Perhaps his definition of natural is a little more limited*?

He claims that an increase in the length of the first stage of labour between the 50's/60's and today is proof that women are loosing the ability to give birth properly but fails to take into account changes such as maternal age and obesity which are likley to play a large part in that. He actually seems to suggest that the use of artificial Oxytocin is causing an evolutionary change, a use ot or loose it effect, where natural production of oxytocin is disappearing. The idea that such a species wide evolutionary leap could be wrought in a couple of generations is bizarre.

Are there problems in modern childbirth? Absolutely, but I don't think any of those problems will be solved by one, publicity hungry, retired doctor, spouting off in the Daily Mail to flog a book. It only builds confusion and conflict. I also don't think we will make childbirth better by prescribing exactly how it should be done. Natural birth is a great choice for many but modern medicine has saved countless lives. The two must be balanced and women's choices respected. Many mums will want to avoid drugs in labour, others will want the very hurty thing to stop hurting and when there are good modern options with minimal side effects why shouldn't they make use of them? I don't think that having an epidural prevents your atonement for the sins of Eve and I don't think it'll turn you into an irresponsible mother either. It's just a choice and surely choice should be encouraged?


*Oh and the Dolphin/shark thing?...

The Quote is a bit hard to see but reads:  "This film explains why millions of women, all over the world, dream of giving birth in the sea, among Dolphins" - Dr Michael Odent

Perhaps this is why Odent Doesn't class that 40% of "normal" births as being properly natural, they just haven't gone far enough! I really hope this is a spoof but it seems like some people have extrapolated from Odent's idea for birthing pools to the point where they now advocate giving birth in the sea with "Dolphin attendants". Yep, what could be more natural than bringing your child into the world surrounded by cold saltwater, large marine predators and whatever other beasties decide to come along. I can't see anything going wrong there, oh no! All that's just my opinion of course, but at least I'm making that clear.

Friday, 15 May 2015

The Measles Vaccine - With Extra Life Saving Bonus

Or - why science is amazing and wonderful and cool.

Two things happened this week which reminded me just how fascinating science, and especially biology, (sorry Prof. Brian Cox) can be.

Firstly I gave a tour of our lab to some non scientists. I had 45 minutes to fill and it was a little daunting. Our lab is very specialised and technical, I didn't want to either bore them with incomprehensible science-speak or come across as some patronizing smart-arse. I think I pulled it off, and most of them seemed genuinely interested and amazed by our equipment and what we can do with it. I sometimes take it for granted that I'm involved in complex, novel research every day. So every now and then it's nice to be reminded that this isn't ordinary stuff to most people. Chatting to a colleague about it afterwards we both realised that - yeah, this is a pretty cool job, we can do stuff and find out things that would have been impossible just a few years ago and we're very privileged indeed to do that every working day.

The other thing I got chance to do was catch up on some reading. I worte some posts about Measles and measles vaccination a while ago but I'm by no means an expert on this subject and since then I've learned some new stuff. This is sort of a good news / bad news thing:

The Bad News:

I hadn't realised that getting through a case of the measles, as I did when I was five, didn't mean you were in the clear. There is a (thankfully rare) condition called subacute sclerosing panencephalitis (SSP) which can occur years after the initial disease seems to have gone away and which is sadly usually fatal. As I said, it's rare,  perhaps around 1 in 10,000 measles cases will go on to become SSP although the exact number is unclear and there is no specific diagnostic test for SSP, so it's quite possible that, since it could be 15 years since an SSP patient had the measles, the link might not be made. The good news here is that SSP is now very very rare indeed because vaccination means there are so few cases of measles in the first place (There is even an early episode of medical drama House where SSP turns out to be the mystery disease). But that isn't actually the main good news....

The Good News:

A new study suggests that the measles virus, as well as being potentially deadly and making you feel pretty damn miserable, also does a sort of factory reset on your immune system. By the time it's done you have good immunity to the measles but all your immunity to everything else is gone. All those immune cells that remember other, previous battles, against other diseases are wiped out. This means a fairly robust school child suddenly goes back to having the immunity of a vulnerable new born and in some cases it can take up to five years for them to get back to their pre-measles state. The study authors suggest that pre- vaccination, half of all deaths from childhood diseases were caused, indirectly, by measles.

Errr - how is this good news?

It is honestly  - hang on in there...
The reason we know this, is because it hardly ever happens anymore. Whenever measles vaccinations were introduced to a country the number of deaths from measles plummeted, but so did deaths from every other infectious disease too. Vaccinate against measles and you don't get measles which also means you don't get that factory reset of the rest of your immune system.

My immediate question was - how do we know it was the vaccine preventing the other deaths? Could it just be a coincidence? perhaps the vaccine was introduced at the same time as better food or sanitation? The correlation v causation question is always worth asking but in this case it really does seem to be the vaccine doing the job. The same dramatic fall in deaths is seen repeatedly in different decades and countries. Measles vaccination wasn't introduced to Denmark until 1987 but the same thing happened there, a rich, developed country. In fact the reduction in non-measles deaths is even more prominent in wealthy countries where most kids will survive measles and so go on to that susceptible period afterwards. Sadly in poorer countries many children never make it past the initial disease. Measles still kills 140,000 people a year.

This study also provides yet more evidence against some common anti-vaccination claims. Firstly there is the idea that catching a disease gives better immunity than vaccination. There is no evidence for this anyway but now we also know that catching the measles, rather than being vaccinated, actually wrecks immunity against everything else too.

I've also heard people claim that breast fed babies don't really need immunizations because they get all the immunity they need from their Mum. Breast milk does provide some immune protection although it seems to be fairly short term. But even if nature were as magical as some claim - one dose of natural measles virus and all that would be wiped out.

Biology is fascinated, there is always something new and unexpected, even when you have been studying and working with it for decades. Measles vaccination can now be considered one of the best and most cost effective health interventions on the planet. It's saved countless young lives and prevented a huge amount of suffering. But humans are pretty amazing too - we might not have realised how good it would be at the time but we made that vaccine and every scientist who worked on it, every health worker who delivers it and every parent who brings their child along has played a part in saving countless young lives.

I spend a lot of time on this blog saying "the press have hyped it up" or "the results don't really mean much" but we should celebrate our triumphs too. There is a lot of good news in science, a lot of genuine progress is being made. I wish more people could share in the complexity, beauty and wonder of it.


Saturday, 9 May 2015


Imagine you are taking part in some sort of extreme sport endurance event, say a really long, non stop hike. You're not at peak fitness but, at the start, it's going ok. However, 20 or 30 hours in it's got a lot harder, you're climbing up ever steeper hills, tired and in a lot of pain. It's as much a psychological battle as a physical one, you want to give up but you force yourself on, up the next hill and the next, you can't even see the finish line yet. Then suddenly something happens. Maybe an accident or an injury. The event you expected to be tough but safe has suddenly become life threatening. There are people everywhere and you're rushed to an operating theater for major surgery. You are exhausted and terrified but thankfully you pull through.

Now what you might think you'd need after all that is rest and sleep so you can start to recover. But weirdly you find yourself in some strange world where, not only is it assumed that you'll stay awake, possibly for several more days, but you're also expected to think it's all been the most wonderful experience of your life. Oh yeah and did I mention you'll also be handed the biggest responsibility of your life at the same time too?

(Have I stretched the metaphor too far yet??)

Seems ridiculous right? Of Course people would realise you need to sleep after all that. But swap the endurance hike for a long labour and make the surgery an emergency c section and it's a pretty ordinary experience of an NHS postnatal ward.

The absurdity of that struck me somewhere into my second sleepless night on one such ward. The doctors and midwives were telling me I needed to be in hospital to recover but all I really needed was someone to keep an eye on me, regular pain medication and some rest. I was getting none of those things on that ward (you can read more about my postnatal care here, it's not a happy story) The complete lack of sleep was unbearable. I finally left the hospital on a Thursday afternoon, the last time I'd gone to sleep was the previous Saturday.

Of course we expect new mums to be sleep deprived, it's kind of a grim joke and oh how everyone loves to tell you all about it when you're pregnant. But does that mean that mums don't really need rest to physically recover from a c section or a difficult birth or even a pretty straight forward one? Does one source of sleep deprivation mean you should just accept all others? Noise? Pain? Fear? Suck it up ladies you're a mother now. Major physical trauma is no reason to sleep on the job!

It's also possible that sleep has a roll in psychological recovery. Many women who have had difficult births walk away with just some bad memories or a good horror story, others suffer lasting psychological trauma. There is likely to be a large number of factors involved in determining who develops trauma symptoms but I wonder if sleep, or the lack of it may contribute. Heads up I really am speculating here which isn't very scientific I know, but there simply isn't much research on this at all. We do know that sleep problems are a symptom of trauma and PTSD and there is some (very limited) evidence that sleep disturbance prior to a traumatic event increases the likelihood of PTSD but I wonder what effect extreme sleep deprivation after giving birth might have?

I started thinking about this a few years ago following a conversation with a clinical psychologist. After my daughter was born I found myself telling the story of her birth over and over again in my head. I didn't want to, but it was always there, nagging at me. The Psychologist explained that sometimes difficult memories get stuck, the brain fails to file them away as it should and they remain rumbling around where they aren't wanted. We do know that sleep is important for consolidating learning and memory, could it be that sleep deprivation after a traumatic event interupts that filing process and increases the risk of problems later on? As I said that is pure speculation I couldn't find any studies on it other than one in mice which actually suggested the opposite. I'd love to see more research in this area.

So, if we accept that new Mums need to be able to sleep, for physical healing, maybe pschological healing and just because oh god how we need sleep - what can be done to make it possible? It's tricky, but I don't think you should criticise something without offering alternatives so here are a few ideas:

The dream scenario: (no pun intended)

Single rooms, space for partners, noise limiting design, lots of time with kind and reassuring staff. This would all be great, but of course it costs money!

The easier stuff:

Respect - staff, mums and visitors should be encouraged to keep noise to a minimum at night. That's surely just common courtesy but it often doesn't happen.

Babies of course can't be expected not to make noise and if there are four or more in a room that could be a lot of noise. So perhaps if there isn't space for single rooms a few quiet spaces could be set up where mums could go to get away from the noise of others for a while, even if only to rest rather than actually sleep. It would be a whole lot better than the night I spent on a plastic chair in a milk pumping room! Or maybe there could be a nursery, not the strictly enforced separation of mum and baby that used to happen, but an option to have your baby cared for by someone else just for a short period of time.

Out of Hospital Care.

Maybe we should also be looking at caring for women away from hospitals all together? Like The Duchess of Cambridge, many women who have straightforward births now go home within hours, but could more complicated cases also be cared for at home? If there was better and more consistent out of hospital post natal care then many more women could probably go home sooner. Even after my emergency C section all I really needed was pain relief, occasional basic checks and some help with breast feeding. All that could have been done at home, in my own bed, with my own food and no noisy strangers. I was only minutes from the hospital if there was a problem. This level of home care is already available to a lucky few who have NHS caseload midwives. It would be great if it could be extended to everyone who wants it.

Ultimately being a new Mum is bound to be exhausting but the noisy and chaotic environment of post natal wards and the resultant lack of sleep is something many women struggle with. I've heard several Mums say that their experience on the ward was far worse than the birth itself. Surely it's worth taking a few simple measures to promote rest and recovery? Is it really indulgent or ridiculous?

This post goes along with the end of the #MatExp ABC on twitter. There has been a lot of talk about creating  safe, comforting and calm environments for women to give birth in. The Maternity experience is, for most, just the start of a lifetime of joy, and hard, hard work, I think we should extend that nurturing and care for just a little longer, so that mothers can head out into their new life ready for all the trials, and all the wonder, to come.

Home, asleep