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/

Shoulder dystocia page now online!

Shoulder dystocia is a popular reason given for restricting the choices in how and where we give birth as bigger women.

But is this fair?

The potential consequences aren’t great, and as bigger mums we’re told that we have a 3 or 4 times greater risk. But a look at the evidence, as usual, is not that clear cut.

More information here.

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.