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.


Monday, 21 November 2016

Silencing Negative Birth Stories

Silencing negative birth stories only helps to create more, robs women of their voice and treats us like delicate snowflakes who can't be trusted with the truth. Remind me again what century this is?


That seemed to be the message on twitter recently, from a senior midwife to women who've had difficult experiences of childbirth. She wanted more women to share their positive stories so that midwives could learn from them. But warned against sharing anything negative with our daughters or pregnant friends.

I'm not going to go further into names or details because this opinion is hardly unique. It's one I heard a lot when I was a first time pregnant mum myself, now more than seven years ago. I had however hoped it was dying out because it's flat out wrong for a number of reasons.

Firstly - who gets to decide who can share their story?

We live in an age when everyone can choose to share as much or as little of their life as they like. The right to free speach is brandished like a sacred weapon, even when what is said brings offense or incites violence. In that context are the everyday stories of women's lives so very shocking that they must be silenced? Why should a mother who lost her baby be less entitled to a voice than those of us who took our newborns home safely?

To tell your story, be it positive or negative, isn't a judgement on others. It isn't a lesson in how to (or not to) give birth. But all too often that is exactly how these things are interpreted. Tell a "horror story" and you are clearly looking for sympathy, being dramatic and trying to scare other women. Tell a happy tale and you are smug and judgmental.

Women have been told to keep quiet about our lives for millennia, now that we are finding our voices, let's try to listen to each other. Just listen. And accept the value of differing experiences and insights. Without assuming they say anything about us. Where there are lessons to be learned (for midwives or anyone else) they need to come from the good stories and the bad. Flying is (supposedly) the safest way to travel, but it didn't get there by only investigating the planes that landed safely.

Silencing the negative can also cause real, individual harm. I know this from personal experience, and to tell my story involves a confession: I was willfully, arrogantly, naive about childbirth.

I had always known I wanted children and years before I was ever pregnant I knew I wanted to give birth to them as naturally as possible. I wanted to experience that great universal female act. So I sought out information to help me in that aim. I read the books and websites, I did the classes and I embraced their message: You are made to give birth,  you just need to have faith in your body.

I was told to ignore the negative stories. Women die in developing countries because they are too small, young and malnourished to give birth. In the western world problems come when women are ill, fat, old or just get scared, wimp out and let the doctors start on their malicious interventions.

I had just turned 30, was six foot tall and in great health. I went into labour calm and confident and utterly unprepared for a 34 hour labour with a 9lb 10 oz back to back baby who's head size was off the scale.

I'd given no thought to emergency caesareans other than to tell myself it would never happen to me. The thundering clash between expectation and reality left the experience repeating in my head for years afterwards, and woke me sweating and panicked in my bed long after the physical damage had healed. Ironically, avoiding other peoples negative stories only added to the negativity of my own.

I won't lie to my daughter and say she arrived calmly in a birthing pool just as I'd planned, it is her story as much as mine, she deserves the truth. But I may gloss over some of the details, some of the fear. I'll tell her, as I tell pregnant friends, that I just got unlucky, we were both ok in the end and she was worth every minute. I want her and her sister to know that childbirth can be wonderful, joyous and empowering. But sometimes things don't go to plan and when that happens, if you are lucky enough to live in a developed nation, then modern medicine will usually get you through it. That even if the very worst thing happens, the thing you push from your mind as you stroke your growing belly, then you are no less normal, no less deserving of a voice than anyone else.

Which should surely all be obvious? We live in a time where Women are supposed to be treated as intelligent human beings. Where we are supposed to be supported to make informed decisions about our own bodies. So how does this belief that we can not handle the harder truths and should be shielded from them for our own good still persist?

Being told to hide away our stories of difficult births lest they scare other women seems both patronising and, worryingly for a message that comes mostly from other women, patriarchal: mustn't scare the weaker sex, best pretend it's all candles and cute babies or they'll get in such a fluster they won't be able to give birth properly, or  *gasp* they'll start demanding pain relief or C sections!


Most first time pregnant Mums are grown ups. We know that TV dramas aren't real life and that newspapers pick the most sensational stories. We know that just because something happened to the woman at the end of the street, that doesn't mean it will happen to us. We know that life isn't risk free but we still get up in the morning and get on with it.

You don't empower women by treating them like scared children, by telling us that life is all rainbows and unicorns and hiding the monsters under the bed so we will behave in the way you think best. That is true whether the "you" in question in a husband, a government, a whole society or a senior Midwife.

We need facts and then we need the support to turn these into realistic expectations, choices and personal opinions. We need to be prepared for the wonderful births and the difficult, complicated ones. Then the stories will be created. They may not all be happy, but each one will be unique and each one will be worthy of telling.


I want the truth!
You can't handle the truth!
(no idea what the weird eyes are about on here)

Tuesday, 1 November 2016

The Unreal World Of The Academic Scientist

I'm an academic (more or less). Which is great because it means I don't live in the "real world". No, I was born into a magical land where all I've ever had to do is sit in nice places (mostly Gothic in style), and think. I've definitely never worked in dull, crappy jobs to pay my rent or had to shuffle embarrassed from the supermarket when all my cards were declined. And my ivory tower is free of "real" things like bills and weather, so I've never gone to bed with two coats on to keep warm or lived somewhere where the rain came in through the bathroom wall.

I'm doubly lucky to be not just an academic but an academic Scientist. This means I am untroubled by all those things scientists aren't interested in, like personal appearance, or any kind of art. Even better I never have to bother with those tiresome sounding human relationships. I've never had a broken heart, lost a loved one or tried to juggle all my important thinking with caring for sick children.

Heck no, the real world isn't for me. I just think pointless thoughts, the magic spirits of academia sort out everything else.

Yes, I am being sarcastic.

Yes, this has been known to happen before.

On this occasion it was prompted by Tory MP Glyn Davis:

I'll admit sarcasm isn't a very mature or even a very vehement response. But, like most scientists and academics, I have come across  similar sentiments over and over again. We are seen by some as somehow "other". Different from "normal" people in their "real" world.

Scientists, and academics more broadly, are supposed to be aloof from reality and either baffled by or disinterested in anything or anyone other than our narrow little fields of interest. Ok, I'd be lying if I said there was no one like that. I've certainly worked with a few people who didn't play nicely with others, or consistently turned up in back to front and inside out clothes. But they are memorable because of their rarity.

I have worked with far more scientists who have very full and very "real" lives. My job often involves long periods of time watching experiments with other people. If nothing is going wrong, we chat. Yes about their research, but also about their kids; the problems of picking a school or juggling work and childcare when the cells in your dish won't let you work 9-5, but nursery still shuts at 6. There are fears for elderly relatives living far away or worries about getting another job once the latest fixed term contract is up. These are very ordinary concerns, a PhD certificate doesn't wave them away.

Then there is the related idea that academics have no interest in anything else, that we are lodged firmly and solely in our cold, rational left brains. Well firstly that left brain right brain thing is total nonsense and historically great scientists were often also artists. Science requires creative thinking. Not just looking at something and thinking ooh, that's pretty, but wondering why it is, wrapping your imagination around the question and asking - could it possibly be because of .....?

I've worked with people who have played in chamber orchestras, west end shows and rock bands. People who can draw wickedly accurate (and wickedly funny) cartoons or spend their spare time painstakingly restoring antique clocks. I have colleagues who are fabulous cooks, ultra marathon runners or computer game masters. And lots of people who just like to crash out on the sofa and watch Game Of Thrones, play with their kids or take the dog for a long walk.

Typical academic, turning his back on the real world.

All of my colleagues are extraordinary scientists, some excel in other areas too, but all of them do all the normal stuff. They all have to somehow pay the rent or the mortgage, not an easy task on a post doc salary in central London. They all have to go to the supermarket and take out the bins. None of us were born university graduates. Our institutions don't manage every aspect of our lives for us and unless we are very very unusual our salaries won't run to a PA and team of household staff.

Yet according to Glyn Davies, we aren't "real" and so our opinions, opinions on subjects we have studied and wrestled with for years, can simply be ignored and, sadly, he's not the only one.

A few years ago I was in a minicab and the driver asked me what I did for a living. It's a question that always makes me pause for a moment. Should I tell the truth? "I'm a scientist and I work in Cancer research". It usually goes one of two ways: "ooh that's really...worthy...(silence)" which is understandable, though a little uncomfortable. The other way, the way the minicab driver went, is the accusation that we are all going to hell for denying God (FYI I have plenty of colleagues with strong and varied religious beliefs, we aren't all Dawkins) and that we are hiding the cure for cancer.

The threat of eternal damnation upsets me, the accusation that I'm hiding the cure for cancer makes me furious.

Scientist do live in the real world, a strange little corner of it perhaps, but a corner where some of us get sick with cancer, and some of us die from it. All of us have watched loved ones battle through Chemo and wished there was something better and kinder. All of us have lost people we care about and would have done anything to save. The idea that we would simply let them suffer and die for the sake of some grand conspiracy and our mediocre pay slips would be ridiculous if it weren't so offensive.

We seem to live in a time when politicians sitting in ornate debating chambers and billionaires bellowing at thousands in a stadium, see no need for experts. We are all experts now, just decide what you believe and do a quick Google to find someone who says you're right. Those with power and money can define who and what is real to suit their agenda or prejudices. That scares me.

I want my house to have been built by experts who knew what they were doing. When I buy it I want an expert solicitor who will check every detail and when the boiler goes wrong I want the Corgi registered, highly trained expert to deal with the gas in my home. If my kids are sick I want expert doctors who have spent years and years training and working in that disease and drugs developed by expert scientists who've tested them in every imaginable way.

Because I have no idea how to lay a brick, write a contract or cure a sick a child. I may be an academic scientist, a specialist in my own little field but I don't have time to learn all those other skills, not to the level that people who spend their lives on them do. I'm too busy getting my kids out of the house on time in the morning, ramming myself into the commuter train, trying to meet my deadlines and get through all the laundry before someone runs out of socks.

You know, that stuff people do in the "real world", that place I've never been.


Tuesday, 13 September 2016

Science Tries To Make Babies Without Women, Newspapers Try To forget Us Altogether

Stand down ladies, our work is done. Apparently scientists have found a work around for that one and only useful thing we do: helping men have babies. The poor lads no longer need to put up with us taking up space on the planet, they can replicate unhindered.

Various news sites have been reporting on a new research published in Nature Communications. The articles claim that it may be possible to create babies without an egg, by instead using a sperm and a skin cell. So far the work has been done in mice but we're told that if it works in humans then gay male couples could have babies with both of their DNA or men could go it alone and have a child that is solely theirs. Women, we're told, will not be needed anymore.

The Science Bit

Here's the thing it's easy to miss amid the chest beating enthusiasm: The research was done in mice and it used egg cells. Egg cells that had been tinkered with (so they were a bit more like skin cells) but real life - came from a girl mouse - egg cells.  Scienctists didn't just chuck sperm over supper potent male skin cells and POOF! baby mice. The whole skin cell thing is just an idea at this point, no one has actually done it.

Also, while the male contribution to producing a baby is often little more than the delivery of that one wining sperm, for women there is a little bit more too it; there's that whole womb thing for starters

Because those baby mice didn't just go "POOF!" and appear fully formed in the paternal petri dish. The Misters-are-doing-it-for-themselves embryos were placed into a lady mouse and it was her body which held them, her blood which fed every new cell, every replicating male gene. Scaled up to human size that equals nine months of hard physical work, of pain and sickness and exhaustion. Before you even get to the birth bit.

But this isn't mentioned anywhere in the articles. It's as if this research has wiped women from both the genes and the memory. As if we are nothing but packaging material - something to be tossed in the recycling bin once the goods have been delivered.

I have absolutely nothing against the science. I don't hold with slippery slope arguments and invoking Brave New World or 1984 as a means of stifling scientific curiosity. I want to know about the world, I want to use that knowledge to make it better. This work - and more importantly the work that will follow as other scientists repeat and dig deeper into it - could help us to better understand conception, which in turn could give clues to treating infertility or perhaps preventing miscarriage. I can see why Gay men may want children that share their biology or why a man may want to go solo into parenting, as many women already do.

The Ranty Bit

What bugs me isn't the genetic avoidance of women in the science, it's the complete absence of us from the commentary. If this technique can help two men to create a child why not a woman and a man who would otherwise need IVF and an egg donor? The BBC article doesn't think to mention this but surely our female skin cells are as capable of transformation as a mans?

And where is the discussion on how all those babies will be gestated? We don't have artificial wombs, so where are all these insignificant  human vessels to come from? Perhaps it's not too surprising that The Sun, a paper that glories in supplying men with women's bodies, didn't question this, or dwell over long on the more subtle potentials of the science. Instead it ran with the headline:

Well in that case ladies, I say we let them. I've done three pregnancies, ending in three surgeries, let's let the "blokes" reading The Sun take a turn with the stretch marks and heart burn, with the months of exhaustion and worry, with the uncertainties and risks of giving birth. While they're at it they can have menstruation and the menopause too. Because I think our half of the species is long over due a break. When is science going to come up with that?


Saturday, 27 August 2016

Surprise! Dolls Don't Stop Teenage Pregnancy

A young woman is woken in the middle of the night by the sound of crying. This is the third time so far and she is exhausted. She pushes back the duvet and swings her cold feet to the floor, wondering what awaits her, another feed, another wet nappy? What has the programming decided to wake her for this time?

Fake baby dolls have been used all over the world for years to scare teenagers, usually girls, off the idea of getting pregnant. If you've experienced the utter soul sapping exhaustion of caring for a new born it seems like common sense, give a teen a taste of that and they will be put off the idea of taking it on for real. Right?

Except assumptions, even when they seem so obvious, can be wrong. This is why sometimes we need people who ask seemingly silly questions and scientists who will answer them.

Scientists like the group in Australia who looked to see if the baby dolls really did lower the teenage pregnancy rate and found that not only did the dolls not reduce the number of girls getting pregnant, they actually seemed to increase it.

Given how widely the dolls have been used it is perhaps surprising that no one has ever done a proper scientific check before to see if they actually work. But there is no published data. So the Australian team set up a controlled trial. They recruited 57 schools and randomly assigned them to be either test sites, where the doll program was run, or controls who just got standard health education classes. In all, almost 3000 teenage girls were involved and the researchers used medical records to follow them up until they reached twenty.

When they put all the numbers together it was clear that those who took the dolls home were more likely to have a baby or an abortion in the subsequent years.

But perhaps that shouldn't be such a surprise. It strikes me that the doll program grossly oversimplifies both being a mother and being a teenage girl.

Firstly, girls often only get the dolls for a weekend, and while two or three nights of disturbed sleep is tough, it's nothing compared to the accumulated exhaustion of being in demand 24/7 for months or even years. I also doubt the cry of a plastic toy could truly grab you by the heart and guts in quite the way that the scream of your own flesh and blood baby does.

Besides, real life new mums are taking on far more than just sleep deprivation and night feeds. There's the physical after effects of pregnancy and birth, the constant worry over keeping the baby safe and over every one of a million choices in how to raise it. Then there is the probably permanent loss of your previous, child free life. Nothing in the world can truly prepare you for the realities of becoming a mother. So it's perhaps not so surprising that a weekend with a demanding doll doesn't do it either.

But the dolls failure says less about the girl's inability to grasp the reality of motherhood than it does about everyone else's poor understanding of the lives of teenage girls.

Most of them are smart enough to realise that there must be some positives to motherhood. After all, most women who go through the months of new born chaos are eventually quite keen to do it all again.

More sadly, some teenage girls see few other options in their future. The dolls may give them a breif glimpse of a purpose or even of some kind of status. "Mother" is the only roll that seems both significant and achievable. Even though girls now often outperform boys at school our society still focuses on what women and girls do with our bodies and present motherhood as an essential, an ultimate purpose and duty. Often little else is on offer.

Trying to scare girls off teen pregnancy with a weekend of simulated semi motherhood isn't going to work unless we can ensure girls have desirable and attainable alternatives and that they believe their worth doesn't rest solely in their reproductive organs. That of course is far harder. It also involves the boys. The study didn't look at the effect of boys taking the dolls home or how this may have changed their behavior with girlfriends, their opinion of motherhood or the role of women.

As ever, the responsibility for pregnancy and preventing it is placed entirely on the potential mothers, even when they are still children themselves. Even when the baby is a doll.


Sunday, 21 August 2016

A Mum's Guide To Dodgy Science: Cause v Correlation

Time for another in my (very) occasional series of posts giving you tips on how to spot a dubious science story. The previous posts covered Publication By Press Release and the problem of Comparing People To Petri Dishes. This one has a few less P's in it but it's a biggy, something that crops up time and again in the media: causation v's correlation.

I've touched on it before (in this post), but the problem is essentially this: if a study finds that, say, people who eat lots of broccoli are better at maths than those who don't, then it could be claimed that eating broccoli causes super maths skills. 

But is the broccoli really the cause? It could just be a coincidence or there could be another factor that causes an increase in both maths geekiness and tiny green tree consumption. 

If you fancy making up some correlations of your own have a play on this website, apparently, increasing sour cream consumption results in more Lawyers in New York.

This might sound quite obvious (not the sour cream bit) but it's all too easy to fall for it. Especaially if the cause and effect seems to back up our own beliefs. This is a whole other problem (known as confirmation bias) and it's really really hard to avoid. Show me a headline that says getting a science degree causes you to be a totally awesome person and a little bit of me would be very happy to believe it (ok a pretty big bit). The moral of the story is, if you disagree with the findings of some research, be skeptical about it. If you agree with the findings be really, really skeptical about it.

So if we accept we are all just human, how can we spot when there is a causation v correlation issue in an article? 

There are some key phrases you can look out for, things like "linked to" "associated with" "relationship between" . Basically anything that suggests a connection between two things but doesn't explicitly say "causes" is a bit of a red flag.

*It's usually the mothers right?

As ever I tend to get around to writing these posts because I saw something that annoyed me, so here's that something:

There is a strong positive relationship between planned birth at home and breastfeeding rates, according to researchers.
Their study review found breastfeeding was twice as likely among mothers in UK and Ireland who had a planned home birth, compared to hospital births.
The article goes on to list a number of reasons why this may be: Home birth mums are looked after by midwives not doctors, they aren't confused by lots of different medical professionals and are less likely to have medical interventions or pain relieving drugs. They might also be more likely to have skin to skin contact immediately after birth and less likely to have formula on hand. 
All of these things are mentioned in the paper the article is based on and they may well all have contributed to the results. BUT there is also a glaring correlation issue:
In the UK and Ireland very few births happen at home. In the two populations studied it was just 1% and 2%. So no one was going along with a home birth because it's just what everyone does. It's a carefully considered and sometimes fought for decision. Hospitals deal with everyone from super healthy twenty somethings to those with multiple health and social issues but home birth mums tend to be similar. They are usually educated, healthy and relatively well off. Exactly the same demographic that is most likely to breast feed, wherever they give birth. 
This issue is discussed at length in the paper, it's such a biggy that the authors spent time on complex stats to try to adjust for things like socio economic status and if the mother had a live in partner. Yet the article doesn't mention this problem at all. 
The paper is also quite clear that, even with those statistical adjustments (and they are never perfect) there is still the issue of belief. 

Those mothers making an active choice to give birth at home do so because they believe it is best for them and their baby. They are fairly confident that birth is a normal, natural event which they are perfectly capable of going through with no need for artificial intervention from doctors and modern medicine. It would be very odd then, for women with that belief not to extend it to the normal and natural act of breastfeeding. 

Sadly belief and determination are not enough to make breastfeeding successful, I write this as someone who had both and had a hell of a time with my fist baby. But they do help, sometimes a lot. Yet the article makes no mention of the importance and power of women's beliefs.

Instead, the story painted is one that fits neatly into the current ideal of childbirth: Doctors, hospitals and pain relief are bad. Midwives, breastfeeding and all things natural are good. 

But to get back to the causation issue - why does this matter?

This article didn't appear in a tabloid paper. It was in a nursing magazine. Most people reading it would expect it to be an accurate source of information and they probably don't have the time to dig through the original research to check on that. Yet the article follows the same formula we see in the general media. It cherry picks the bits of the paper which will most appeal to it's audience but leaves out some very important problems.

We all love a quick fix. Take this pill to get slim, eat today's favourite "super food" and stop feeling tired all the time. But it is rarely that easy. Discouraging doctors, epidurals and formula in the hospital would all be doable and pleasing graphs could be produced of their decline. But it could mean coercing women into births that are more painful or risky than they would otherwise choose. If these things aren't even the main cause of the reduced breast feeding rate, if hospital birth over all is more a correlation than a cause then just jumping into the quick fix could do far more harm than good.


PS. There are a bunch of other issues with article, (including an error in the first paragraph), there are also some weaknesses in the paper but for brevity I've resisted a full rant!

Wednesday, 10 August 2016

How To Cope With Living In London

I have to admit to a little guilty pleasure, the Mumsnet AIBU thread. If you’re not familiar with it, AIBU stands for "Am I Being Unreasonable?" and the answer is quite often yes, yes you really are.

This week someone asked “AIBU to wonder how people cope living in London” which reminded me that I haven’t written for quite some time about just what a great place to live this is. The “Southwark” part of this blogs title comes from my London borough afterall.

The mistake the OP (original poster) had made, was coming to London as a tourist. Yes there are a lot of people here and yes the tube is packed and horrible in rush hour in the summer. The big tourist attractions are little better. But London has high standards. If you only give her a day or two, she’ll let you see the sights and not care if you have to be crammed in with a thousand other people to do it. But if you put in the time, the effort she deserves, then she lets you have the good bits.

I’ve been here for thirteen years now and I still only really know patches of this huge city but here are just some of the things I love about living here:

The Transport:

No, really.
The tube isn’t awful all the time and when it’s not it’s a great way to get about. My visiting parents once declared; “oh good only 10 mintues till the next one” after we just missed a tube. Everyone else on the platform was incensed it was that long, a two minute wait is far more normal. But the thing is, it’s not just about the tube. Where I live there isn’t even a tube line. In fact you don’t need transport a lot of the time. From my house I can walk to several different shopping streets, two sports centers, the doctors, dentists, three children's centers, school and more than half a dozen parks and playgrounds. The shiny new network of segregated cycle ways means I can now ride my bike to work almost entirely off road. The buses, trains and London overground service get me anywhere else in the city. Our car is mainly for trips to other places which just aren’t so, well, good.

It’s a great place to raise kids:

Firstly London has really good schools. Years ago they were awful, but for a quite a while now they have been the best in the country. Then there is all the free stuff to do with kids. The national history museum, science museum, British museum, V&A, National Gallery, Tate Modern etc. etc. etc. are all free. So there is no need to drag around for hours after it stopped being fun so that you see it all in your one day window. We can hop on a bus or train, look around for an hour and then go to the park for a bit. Safe in the knowledge that we can come back any time we like. Oh and the bus and train are free for the kids too. For older teens this means the whole great city is there to entertain them, for nothing. For MissE it's meant a long list of cheap or free school trips. No need to pay for a coach when the class can all just pop on the bus at the end of the road.

You can be whoever you want to be:

In London you are never the weirdest person on the bus, and (for the most part) that’s a good thing. You can dress however the heck you like (just do it like you meant it). There is no single "normal" to blend into anyway. Want to go sailing and horse riding? Ok, knitting group? Coding class? Art house cinema? Whatever your passion (with the possible exception of Bobsleigh I suppose) you can do it in London. You’ll probably also find others who share it, who come from your home country and are seeking out the same food, or maybe even like the same odd kind of music as you.

There is always something new to discover:

You could spend a lifetime visiting different London restaurants, trying new international cuisines and never get to all the good ones. You can never tire of sightseeing either. Once you move beyond the obvious tourist sites there is still so much to see. I recently altered my route to work a little and discovered some of the Inns of court. There are beautiful churches, cobbled streets and grand Georgian squares. It’s all a short walk from St Paul’s Cathedral but you have to find and step through the unassuming archway on Fleet street to get in. Few tourists notice it, so it feels like a secret, hidden world.

So yes it is busy and hectic. The tube is horrible in the summer (and worse in the winter when it’s almost as hot but you’re wearing a coat). The house prices are horrific and the rents not much better and maybe one day I will move on somewhere else, who knows. But for now I for one am not just coping with living in London, I’m loving it.


Tuesday, 26 July 2016

A Missed Miscarriage

I had hoped that today I would be sharing some happy news on this blog. First thing this morning I was supposed to be going to the hospital for a twelve week scan, a first look at our third baby. But sadly that appointment had to be cancelled.

I’ve been wondering whether to write about this on the blog or not. A miscarriage early on is a complex thing to grieve for. As a biologist I know that technically there never was a baby, just an embryo. So can I say my baby died, when it never fully lived? Yet of course I do grieve for it, or the idea of it at least.  I also don’t deal well with being on the receiving end of sympathy, like compliments it flusters me. Does a blog post risk seeking that out?

But then I share or perhaps over share so much on here that it feels odd not to talk about it and for me, writing things down, doing my best to form them into some kind of narrative, is often therapeutic. Miscarriage still seems to be something people don’t really talk about. Perhaps that in itself is a reason to write about it? It is such a common, ordinary thing, something I know many people reading this have also been through. Would it make the whole sad, lonely process a little easier if we could all be open about it?

I don’t really have any answers right now. But I’m going to share something I wrote on July 16th, the day after my “Surgical Management of Miscarriage” operation. I’m also sending out love to all those who have had similar experiences, whether I know you or not, whether you told me or not. The telling of the story isn’t the important part, this is just my own reaction to events, everyone else’s will be different.


There never really was a baby. So I can’t say I lost it, or that it died. There was a bunch of cells, perhaps some tentative, primitive form. But it’s heart probably never made a first beat, it’s brain never sparked a first thought. It hovered for a few, hope filled weeks on the blurry brink of life and then simply faded. Until all that was left was some indistinct grey pixels in a black void on an ultrasound screen.

Yesterday the surgeon, nurses and anaesthetist brought to an end that which nature had long since given up on but couldn’t or wouldn’t let go.

I’ve had three pregnancies and they have all ended in an operating theatre. The first surgery was a terrifying emergency, the second calm and joyful, but with both of those I went home with a healthy baby girl in my arms. Yesterday I was processed, slowly but kindly, from a waiting area, through forms and tick boxes into theatre and then woke up, not long after, in my designated recovery bay. But this time I was alone. These was no baby in my heavy arms and nothing was left in my womb where it had tried to grow. It was quick, efficient and, after two weeks of waiting and worrying, it was over. I was glad of that but I wished these arms of mine weren’t so heavy. I couldn’t lift them to wipe away the tears that finally came.

It is one of those great dreads of early pregnancy, the blank ultrasound, a “missed miscarriage” an “early embryonic demise”. This pregnancy had taken far longer to begin than the others and so I had paid for an early scan at eight weeks. I had a day off work anyway and I thought it would help set my pestering worries aside, that I could treat myself to a first look at our new baby. But in the smart third floor office of a Georgian town house the big flatscreen TV on the wall showed only a black hole. A small, almost empty gestational sac, no obvious baby, no flickering heartbeat.

The next morning I sat on the floor in a hospital corridor with all the other women who were tired and worried and waiting for the early pregnancy unit to open. When my turn came the scan showed just the same. But biology always evades direct questions. Perhaps, just perhaps, it wasn’t eight weeks afterall. A few days here, another few there, a test showing a little pink line a bit earlier than it should have. Perhaps, at a pinch, it was just too soon to see that flicker of a heart? The doctor said it might all be fine, I should come back in two weeks.

But I did the maths over and over again. The dates on the app that tracked my periods, the date of the tests and how early that little pink line should be possible. I tried to find hope but I also pressed a sanitary towel into my underwear when I went to work and closed my eyes for a second whenever I went to the loo, please, no blood.

At the next scan, after those two long weeks,  they didn’t show me the screen. The doctor, who seemed to be new to the department or perhaps just quite junior, didn’t want to make the call either way. There was something in the sac, strange and amorphous, but there. Yet still no heartbeat. She called for her senior consultant and I lay there, torn between hope that perhaps my maths was just rubbish and the tiny creature inside me was growing after all and the dread of more uncertainty, of another long wait.

But the consultant knew that the blob would never be anything more. It must be horrible to break that news to women over and over again. Or perhaps it stops bothering you after a while but either way she did it with kindness and certainty.

So, ten weeks into the pregnancy, I knew there would be no baby. She/he was a fantasy based on a bundle of doomed cells and the hormones still thundering through my body. The hormones that had forced me to spend the evening of my birthday layed flat on my bed as they world span sickeningly every time I tried to stand up. The hormones that made me ache to the bones with tiredness and gave me bouts of nausea only controlled by the eating that had piled pounds on my belly already. All the things I had happily accepted, believing they were good signs of a healthy pregnancy.

But signs can be misleading. I would not now have a little rounded belly when I took Miss E to her new school in September, I wouldn’t be stopping work at Christmas. I would instead have to choose from three unwanted options. Let nature eventually take it’s course, who knows when and how, take drugs to hopefully speed that up or end another pregnancy in surgery. I chose the surgery. It was at least the quickest and most certain option. But it meant a general anaesthetic, something that terrifies me. I signed the forms and went home to make arrangements.

Perhaps being a biologist helps in all this. I know miscarriages are common. That a random mismanagement of chromosomes is probably to blame and that, as far as nature is concerned, I am well past my reproductive prime anyway. I know that technically what grew in my belly never even achieved the status of “fetus”, nevermind baby and that wiser people than I have argued forever over whether something that tentative is actually alive.

I also know that, for me, it would have been worse to see that empty sack  at the 12 week scan. To have suddenly, unexpectedly started bleeding and cramping or to have lost an older, more tangible baby.
But for now, I will sit on my bed while the house is quiet. With my surgical stockings and my painkillers and write this all down. That baby will never grow in my belly or come home in my arms. It’s almost life will matter not one jot to the world and I will carry on, just hugging my girls a little tighter.

But I will grieve for the baby that could have been. Even scientists know that biology isn’t everything. That a dream can be more than the genes and cells and almost life it is based on. So perhaps it doesn’t matter that there never really was a baby. There was love and hope and they are real enough. I will cling to them and send them drifting out to the stars. To them we are all just brief moments, just flickering bundles of cells and barely tangible life.


Saturday, 16 April 2016

Choosing A Caesarean, And Having that Choice Refused.

I seem to write endlessly about caesareans on here, it was never my intention with this blog, but hey that's the joy of having one's own little online vanity project. Often I'm writing in response to news articles on the subject and almost always those talk about the terrible rise in C sections, how unecessary they are etc. etc. It's seems very odd then to have been seeing stories yesterday about the dangers of women being denied caesareans. Except that those headlines chime more with my own experience.


Almost two years after MissE was born I attended a birth "debrief" at the hospital. I'd been trying, all that time, to just forget about it. I had a healthy baby after all and that's supposed to be all that matters. Dwelling on how horrible the birth had been for me seemed self centered and unforgivably ungrateful, two attributes no good Mother is supposed to display. But we were thinking about baby number two and I wanted to at least understand what had happened and why and perhaps be a little better prepared next time.

To that end, I asked what my options would be. I had imagined the hospital would be supportive of a VBAC (Vaginal birth after caesarean), they had been keen to tell me, almost as soon as MissE was born, that I could have one with the next baby. But I hadn't expected to be told so firmly that I had no choice, I would have to attempt a VBAC, it was hospital policy.

At the time I was undecided, if anything I swayed towards wanting the VBAC, it was a chance for a do over, to show I could do the whole birth thing after all, lay some personal demons to rest and perhaps avoid another long and terrifying postnatal stay. But even so, I was shaken by the assertion that I had absolutely no voice in a decision about my own body.

I was also told that there could be no short cut to a C section if the labour went badly again. I would have to work my way through the same list of medical interventions all over again, each one spaced out by the specified hours of waiting and contracting. I did have the right to refuse the interventions, but not to demand one I wanted, so those hours would always remain.

The only other option, were I to persist in my unreasonable request, would be to try to convince the team's psychiatrist that a caesarean was vital to my mental health.

In effect, there were two way to "choose" a caesarean, serve your time for the required number of hours in  a difficult labour or convince someone that your decision wasn't considered, informed or pragmatic but the symptom of a psychological condition.*

Hospital Policy

I can't say for sure why this was the hospital policy, I very much doubt it was based on safety or clinical consideration as, although there are certainly risks to caesareans, over all it is questionable if they are greater than for a VBAC and every case is different. As far as I could tell a VBAC would have been very slightly safer for me but equally slightly riskier for the baby and of course that all assumes that the VBAC works out, an emergency C section is much riskier than a planned one.

Which leaves me to to speculate on two possibilities. Either the hospital wanted to stop women having C sections so they could reduce that much talked about % caesarean rate or they were trying to cut costs.

Which is where this weeks news stories come in. They stem from the tragic case of a baby who died from oxygen starvation after extended attempts at an instrumental vaginal delivery. His mother had asked throughout the pregnancy and birth for a Caesarean, having been warned she would need one after a previous difficult birth but she wasn't listened too. Instead she got ventouse, forceps and an episiotomy, the instruments used with such force that she was repeatedly pulled off the bed. Eventually an emergency C section was done, in the rush the mother had to have a general anesthetic and the father was sent out to wait alone with no idea what was going on. But it was too late and baby died a few days later. The coroner investigating concluded that the hospital, and others were denying women C sections in an effort to save money.


The money thing though is tricky. I've seen various figures chucked into this story saying a c section is twice or four times the cost of a normal birth. I have no idea which, if any, are accurate so I'm not going to list them here. To me those figures are a bit meaningless anyway. Firstly, no woman gets to choose between a C section and a normal birth because no woman gets to choose a normal birth. You can hope for one, as I did with Miss E, but if it doesn't work out that way and you end up with all those hours and interventions and the emergency Caesarean then that "normal" birth is suddenly way more expensive than a quick elective C section (In the states, elective C sections are often considered cheaper because they are so much quicker).

Also, I am not convinced that cost is the major driving force behind refusing women C sections. Which ever figures you use, the difference in cost isn't actually huge, we're talking a grand or two not tens of thousands here. Surgical birth may be more expensive, but frivolous maternal request caesareans are not to blame for the troubles in our beloved NHS.

To me a more likely culprit is those percentage targets and the wider, deeper, paternalistic treatment of pregnant women. For every story of a women denied a caesarean there is another who felt forced into one.

The charity Birthrights held a conference this week called; Policing Pregnancy. It looked not just at birth but at some of the other ways in which pregnant women are treated not as rational , individual human beings, but as merely potentially hazardous vessels for the future generation. This Storify of tweets from the event is well worth a look.

When I did get pregnant again, my uncertainty over how I wanted the baby to be born disappeared almost immediately. My desire to prove myself by finally having a vaginal birth just went. I knew I wanted the safest possible option for my baby and that I would rather know in advance that I would have to endure a c section than leave it up to chance again and risk another emergency one.  But this decision meant that I spent the first few months of that pregnancy absolutely dreading my first appointment with the obstetricians. It hung over me as a constant dark cloud. I had moved to a new area and a new hospital but that first consultant's assertion that I would have to have a VBAC or else fight my case with the psychiatrist, stuck with me and I didn't feel like I had much fight left.

He Listened

I was called into that first appointment, unusually for the NHS, a little early, before my husband arrived. I sat alone in the chair next to the doctor and tried to summon the courage to stand up for myself. I couldn't entirely keep back the tears when he asked me to tell him what had happened last time but the odd thing was, he listened. He said he was sorry I had been through that and then he asked me what I wanted this time. He didn't tell me what I should do, what his opinion was or what hospital policy dictated. He did apologetically say that he had to tell me a VBAC would be safe but otherwise he said very little, other than to answer my questions.  After a while the consultant came in, one of those "old white men" who are supposed to want to tell women what to do, but he listened too and wrote in my notes, so that no one could over rule it, that this time it would be my choice. I was a capable human being, I could weigh up options and reach a decision that wasn't the product purely of ignorance, fear or mental illness. The person who would decide what would happen to my body, was me.


*This took place shortly prior to the introduction of NICE guidelines which recommended women wanting a C section without medical reason should be given counselling to look into their fears but ultimately given the surgery if that remains their choice. Done well, this sounds like a good idea although it seems in practice it doesn't always happen and there is a fine line between exploring a woman's fears and trying to persuade her to change her mind. Arguably with one emergency C section already under my belt my request wasn't entirely without medical reason anyway.