How Risk Is Presented In Pregnancy

Today, Big Birtha was honoured to participate in a discussion about how risks are presented to women in pregnancy, organised by the British Pregnancy Advocacy Service (BPAS).

The room was filled with intelligent, interesting and influential women, from many different backgrounds, but who all share the passion that the way things are at the moment needs to change, and what can we do to bring about this change?

After years of running this blog, and feeling pretty isolated at times, it was so lovely to be in a room of like-minded people who agree that actually;

It’s not OK to make women feel failures that they are providing a ‘suboptimal’ host for their baby for whatever reason; be that because they dare to be overweight, or over 35 years of age, or have a medical issue controlled by medication, or want to enjoy the occasional glass of wine, or because they haven’t been taking folic acid and other dietary supplements religiously since reaching childbearing age just-in-case…

It’s not OK that statistics are often presented in the most alarming fashion possible – where relative risks are focused upon as routine because it’s a sure-fire way to make very small discrepancies look much more significant and scare the bejeezus out of us.

It’s not OK to unduly worry women and make them feel guilty about their situation, when that additional stress serves no purpose, can actually be detrimental, and is often at a point where the woman is not in a position to do anything about it.

It’s not OK that during a time when a woman is most apprehensive and in need of support and reassurance that she can be made to feel like she’s a bad/selfish/negligent mother who is undoubtedly doing harm to her unborn child, when she’s probably doing the best she can right now, probably has a perfectly healthy baby gestating inside her, and needs to be able to build rapport with and trust her care givers, not feel wretched every time she has contact with them.

It’s not OK that studies tend to focus exclusively on the behaviours/circumstances of the mother when drawing conclusions (usually negative!) about maternal actions and the consequences on their children (and sometimes their children’s children!), completely ignoring paternal and other societal influences role to play.

It’s not OK that when the media reports on scientific studies and research that the results are often presented with implied blame on the mother, usually from the most sensationalist angle, and that studies with poor methodology but the most sensationalist claims get more attention than those that are more balanced and better planned.

It’s not OK that women aren’t trusted to be able to look at the evidence (or sometimes lack of it!) for themselves in order to reach their own decisions about what’s best for them, their fetus, and their family, and instead are regularly presented with an oversimplified version of the available research, or worse still, a blanket ‘this is policy’ with no justification whatsoever.

It’s not OK that women routinely don’t feel supported in their ‘high-risk’ pregnancies, but that they’re a problem or ticking time bomb to be ‘managed’.

The fight for a more balanced, consultative, and respectful treatment of women in pregnancy is far from over, but this meeting really felt like the start of something positive.

If you want to see more of what BPAS have been doing on this topic, they’ve written some great press releases here:

www.bpas.org/about-our-charity/press-office/press-releases/

What hope if even UNICEF repeat flawed research conclusions?

Doing some research for this site, I chanced across the Baby Friendly Initiative page at UNICEF.

Now, don’t get me wrong. I’m all about the breastfeeding. It’s great in so many ways.

But UNICEF, in its clear desire to extol the virtues of breastfeeding, have saddened me with their keenness to repeat lazy research conclusions which state that breastfeeding reduces BMI, clearly made by people who are unable to distinguish between correlation and causation…

Update 2017 – (http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Obesity/Breastfeeding-reduces-obesity-in-middle-aged-mothers/ – link no longer works as Unicef seems to have withdrawn the article – a good thing, in my opinion.)

Let’s read the title again; ‘Breastfeeding reduces obesity in middle-aged mothers’. The authors of the particular study UNICEF is reporting on concluded that while having more children is associated with higher BMI, ‘this increase would be offset if women breastfed’.

What the authors of the study actually discovered, was that women who breastfed had lower BMIs, that’s all. This is not new information. In fact, UNICEF reports it here, in a study two years prior to the one above, which makes no such unfounded claims.

Update 2017 – (http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Obesity/Does-maternal-obesity-impact-on-breastfeeding-outcomes/ also appears to have been wihdrawn)

…obese women plan to breastfeed for a shorter period than normal weight women and are less likely to initiate breastfeeding… studies found that obese women breastfed for a shorter duration than normal weight women…

How the authors of the first study concluded that this meant that breastfeeding reduced womens’ BMIs, I do not know, but I’m very disappointed that UNICEF would then publish such an unfounded conclusion as fact, and even more disappointed to find they’ve done it TWICE:

http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Obesity/Persistent-effects-of-womens-parity-and-breastfeeding-patterns-on-their-BMI/ (edit Sept 2015 UNICEF seem to have withdrawn this from their site)

Another article by the same authors, with similar conclusions:

The reduction in BMI associated with just 6 months breastfeeding in UK women could importantly reduce their risk of obesity-related disease and their costs as they age.

Now, perhaps it is true. It’s often reported that breastfeeding uses up to 500 calories a day:

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/why-breastfeed.aspx#close

But let’s be clear about this, until there is evidence of a causal link between increased breastfeeding duration reducing BMIs, rather than a correlative link of women with higher BMIs breastfeeding for shorter durations, I’d really expect UNICEF to understand the difference.

We’ve got to do our own research…

While there is no denying that there are excellent caregivers in midwifery services, there are unfortunately those for whom the magic of childbirth has been subsumed by the sheer hard work and for whom midwifery seems to have become ‘just a job’.

Even the most caring of midwives have procedures and protocols to follow, and delivering truly individualised care amidst the pressures of understaffed units and the highest birthrate for decades is nigh on impossible.

Talk to any woman who has given birth, and there’s usually an element of their birth stories which runs ‘I had to do XYZ / have XYZ / go to XYZ, because of hospital policy on…’

Whether that’s being told you have to go home again for the third time, despite having been in labour for 6 days because you’re not dilated enough (seriously?), or being told you can’t be in established labour because your contractions aren’t regular enough (yet it turns out you’re 4cm dilated), or being told that you need to have your labour augmented because it’s not moving quickly enough (for who?), or you can’t use a hospital birth pool because you’re not thin enough and would be difficult to rescue in the case of a collapse (yet you’re allowed to have as many baths as you like – in tiny room far more inaccessible should the much-feared collapse occur), or your husband/partner/father of your baby can’t be by your side because visiting hours haven’t started yet (don’t get me started on the Bounty lady being there when husband/partner isn’t), most of us don’t challenge what we’re told.

It takes a strong person, while in labour, attended by the experts to say ‘hang on a minute – what are my options here? What if we don’t do XYZ and just wait and see? Or I’m not going anywhere until someone takes me seriously and listens to what I want to happen here.’ It takes a strong birth partner to do it too. I quote this:

The Mule: Stop Googling Your Birth Options, And Hop Up On The Bed, Dear.

If you are faced with a choice about procedures and interventions in childbirth – ask yourself – who is this most likely to benefit, reassure, or make comfortable – me, or my carers? We must not be deterred from learning as much as we can about our rights and our options in childbirth, no matter how much it may inconvenience midwives or doctors. We do not have to comply with their suggestions, unless we wish to. We are allowed to be powerful in childbirth. What’s more, birth is not simply a means to an end – our birth experience matters, and is of primary importance, not just to us, but to our babies, our families, and the whole human race.

The midwives themselves don’t even necessarily agree with the official policy they have to present to us. When I spoke with the Head of Midwifery about my desire for a home birth and my belief that it was a safe, sensible, viable option for me given my previous birth experience (and that frankly, I’d been pushed into a corner because home birth was the only way I’d get to labour in a pool due to their hospital’s policy on BMI) she couldn’t have agreed more. She was very supportive, but still had to sign off my birth plan with ‘against medical advice’ because that was her job, no matter how unfair, discriminatory and ridiculous she felt it was.

She said she felt that midwives hands are often tied these days into following policies they don’t believe in.

But WE don’t have to follow those policies. It is our right to research, and choose, and question, and challenge, and while some professionals don’t like it, be rest assured others are smiling inwardly because they actually agree with us… they just can’t say it.