Wednesday, 1 October 2014

In Which SouthwarkBelle Says Something Nice About The NCT


The following statement may come as something of a surprise to regular readers of this blog.

Well done the NCT!

No seriously.

Last month I wrote about a new piece of research showing that inducing labour wasn't as problematic as is often made out. I included a quote from the NCT website:

Induction of labour may set off a ‘cascade of intervention’, and before you know it you may be drawn into having drips, electronic monitoring, epidurals and all the trappings of a medically complicated, high-tech birth

The website went to to suggest a variety of dubious, unproven and expensive "alternative medicine" ways to start labour.

I thought I would send the NCT a link to my post and suggest that they update their website. I've been quite critical of them but it seemed only fair to be open about that and give them the opportunity to respond. They did reply, but to be honest I wasn't holding my breath.




Now I'm not claiming any credit for what happened next, the page was very clearly out of date so the NCT  may well have been working on it anyway. Also Pseudoscience debunker in chief Ben Goldacre is speaking at the NCT conference this weekend which may have been a nudge. I tweeted him a link to my post today and got this, very encouraging response:




(although I would add that the page was current when I wrote my post so I'm at most 3 weeks out of date!)

Sure enough if you go to the NCT page now (here) the scare story buzz words are gone, no more "cascade of intervention" and no more unproven, expensive alternative remedies either.

So, genuinely, well done NCT for responding to evidence and for removing misleading information that could have been very worrying to overdue pregnant women.

There are plenty of other things I could pick fault with on the website still, but it's a good start, I'm keeping everything crossed for more of the same.

I'll even say it again,  well done NCT.

SB

Thursday, 25 September 2014

Boob Hacking and Baby Wearing Warriors

I've got a(nother) stinking cold. On the plus side this means I can make use of the greatest of the working Mum benefits - I've called in sick and am home alone with a Lemsip! Yay! (sort of yay). I would go back to bed at this point but there are several tons of machinery and a dozen shouty builders resurfacing the road outside so instead I'm going to share two of the more curious things I've found on the internet while poorly sick.

The - Make The Breast Pump Not Suck- Hackathon:

Breast pumps suck, and not just literally. Once my babies were born I often felt that my sole purpose on Earth was to lactate. Regularly plugging myself into an uncomfortable, fiddly device that made loud Mooo Mooo noises really did nothing to stop me feeling like little more than a one woman dairy herd.

But maybe there is hope. Last weekend MIT media lab held a hackathon. Hackathons are usually intense sessions where software engineers and programmers get together to create something new or solve problems. This event took that idea and applied it to breast pumps, it also brought in designers and, most importantly, the Mums who have to use these things. They then spent 2 days working in small teams to re-invent the dreaded breast pump.

I'm guessing this is the first hackathon with a sewing machine, though perhaps not the first with fake boobs
Photo Credit - Che-Wei Wang


The winning team came up with a tool belt system that allowed for discreet hands free pumping - (apparently you could pump on your commute, can't imagine trying that on the 9.01 with my massive mooing device). It also records data about your milk which you can then track on a smart phone app. I'm not sure how much that last bit appeals to me but it could provide reassurance for women worried about milk supply or quality.

The runners up focused on imitating manual expression by building a bra containing chambers filled with warmable beads that can be gentle inflated. This also sounds like it would be a great help for Mums with mastitis and certainly better than my attempts to juggle boob, hot water bottle and pump while hideously feverish!

Never to young to start hacking (or napping)
Photo Credit - Che-Wei Wang
More info about the Hackathon and the ideas it produced can be found here. Let's hope this is the start of lots more innovation to make Mums lives easier (and less bovine).

Baby Wearing Warriors:

Baby wearing, carrying babies and young children in a sling rather than in a buggy, is increasingly popular. Devotees claim that it promotes attachment (not just physically!) and bonding between parent and child and is more natural as it's what our ancestors did and what many mothers in non-western societies still do. But what if historic baby wearing wasn't about nurturing the child at all or even just a matter of convenience? What if strapping a screaming child to your back was actually a serious military strategy?

In case you're wondering, no, this isn't serious but it did win an award at last years BAHfest - that's the Bad Ad Hoc Hypothesis festival by the way, and it made me giggle:






Right I'm off to make another Lemsip and probably a large mug of tomato soup.

SBx

Tuesday, 23 September 2014

Gremlins!

I seem to be having some gremlins with this blog at the moment and my banner and links keep vanishing. I'm working on fixing this but in the meantime, should you need them, my contact details can be found here:

Monday, 8 September 2014

Induction - Cascade - Caesarean Section



It's well known fact of modern childbirth: Inducing labour sets off a cascade of other interventions which often lead, with grim inevitability, to an emergency C section.

But is this actually true?

update, 1/10/14 - Since writing this post the NCT have updated their information on inductions and removed the section quoted below. More on this here.


 - Firstly, hat tip here to This Blog - I'm writing my own aimed at people who probably aren't regular readers of Scientific American (confession, I'm not either) and because I have one or two opinions ...



When I went overdue with MissE I dreaded being induced. I'd heard nothing but horror stories and  according to my NCT teacher it was basically entirely awful and unnecessary. It would also completely scupper my plans for a natural birth in a midwife led unit. But at the same time I was BLOODY MASSIVE. It was August, and hot, I was desperate to meet my baby and had had quite enough of being pregnant. So I agreed to booking an induction and did everything I could think of to make that booking unnecessary*. In the event I got my wish (although I still ended up going through much of the induction procedure after 24 pointless hours of contractions... but anyway)

41 weeks. Bloody Massive


So was I right to fear the induction? It seems the answer to that is no.

A recent study has shown that being induced doesn't increase the likelihood of having a caesarean. In fact women having a single baby, who are induced at term or when overdue are slightly LESS likely to have a C section than those who hang on for nature to do her thing. They are also (again, slightly) less likely to have a baby who dies or who needs to be admitted to intensive care.

This goes against so much other information - Can we really trust this new study?

We often see piles of scientific studies that contradict each other, one minute coffee causes cancer the next it cures it etc. etc. so how reliable is this one, given that it goes so strongly against the generally accepted view?

In this case the authors of the paper didn't set up their own experiment or trial. Instead they did what is known as a meta analysis. This is important because a meta analysis is far more reliable than most of the scientific studies that make it into the media. The authors took the data from 157 different trials and did some serious number crunching. Looking not just at the results of those trials but at their weaknesses too. For example, many of the individual trials were pretty small, meaning their results are less reliable than bigger studies. By putting all this information together they are able to overcome most of the errors and biases that inevitably influence the results of individual studies. We rarely find perfect answers in anything associated with biology, but a meta analysis is about as good as it gets.

So now what?

The differences seen are fairly small, they certainly don't warrant more or earlier inductions but they do call into question the generally accepted view of induction.

Here is what the NCT, the UKs largest parenting charity says about induction on it's website:

Induction of labour may set off a ‘cascade of intervention’, and before you know it you may be drawn into having drips, electronic monitoring, epidurals and all the trappings of a medically complicated, high-tech birth. If you go two weeks past your dates, you can ask to have regular checks on the baby rather than have your labour induced.  ...

 Other methods you may want to consider are acupuncture, hypnotherapy, reflexology and shiatsu. There is no clear evidence that these methods work, but they may be worth a try.

This was written before the recent study was published, but it is a good example of the prevailing view of induction. That it is something to be avoided, even when doctors recommend it and that it's better to go with completely unproven* (actually disproven may be better) and generally quite expensive alternative remedies, rather than risk the dreaded descent into a "high-tech" birth. 

Its strong stuff and something I absolutely went along with when I was pregnant. After all, the NCT are the foremost childbirth charity in the UK. We paid a LOT of money to attend a course given by one of their most senior teachers, who told us that everything she said was evidence based. It turns out that that evidence never existed. 

I sincerely hope that the NCT will now update it's website and ensure that it's instructors are giving accurate, evidence based information to expectant parents. Of course there are plenty of people who've had a bad experience of induction and many who ended up with a C-section but the same is true of others who held out for a natural birth and plenty who went into labour at about the right time anyway. Childbirth is unpredictable with or without a medical kickstart.



Looking pretty rough after 34 hours of labour and an emergency C section - but hey at least I wasn't induced!


This is a good news story 

The result of all this is that women are now better able to make an informed decision, and I for one am all for that.  Of course there are still plenty of other reasons why an individual may or may not want to be induced (having been through much of the procedure I entirely sympathise with both sides). Ultimately it will always be a complex and individual decision and the last say must go to the mother. Always. But we can now remove from the decision the fear of that dreaded cascade into the operating theatre. It's simply a bunch of unpleasant anecdotes.

 This study also has implications for the recent advice that all low risk mums should be advised to give birth at home or in a midwife only unit. In these settings induction is unlikely to be available and this may actually increase the number of caesareans. As I've written before we need to ensure that all birth places provide a good level of care. Women shouldn't be scared to have an induction because it means they'll loose the better standard of care often available in midwife units or at home births.

The NCT and others in a similar position of authority now need to get this message out there. Much is made about the problems of fear in childbirth and here is one less thing to be afraid of so let's shout that from the hills. Or at least on the NCT website!

SB
* For what it's worth I was so very desperate to get MissE out that I wasted a not inconsiderable sum on an acupuncture session in the hope of starting labour. I knew, really, that it wouldn't work but I wanted to do something, anything to avoid that induction. Oh and no, it didn't work and yes I am embarrassed I even tried.


Thursday, 17 July 2014

Pureed Evidence - Is Baby Led Weaning Scientifically Better Than Spoon Feeding?



It was puree all the way when I weaned MissE. I'd heard of Baby Led Weaning (BLW) , where babies are given whole foods and feed themselves, but I was terrified of her choking. To be honest, she was my first baby and I was terrifying of pretty much everything. By the time her sister came along, the twin gifts of experience and absolutely no time to over think, meant that I was somewhat more chilled out. I also had no idea how I would manage the infinite chore of peeling, steaming and blending with a marauding three year old in addition to the baby. So I decided to give BLW a go. MissM shared in whatever the rest of us were eating, it saved me a lot of time and worked well. Yes a lot of stuff ended up on the floor, but a fair bit made it into the baby too.



It is unclear if she was enjoying the broccoli, but she was clearly getting nutrition somewhere


Being me, I then decided to do a bit of research. I'd heard plenty of people claiming that BLW was just hippy dippy nonsense but many others were total devotees so I got hold of a copy of the most popular BLW book to find out more.

I was disappointed to find that, rather than offering practical tips for following BLW, much of the book was devoted to criticising puree feeding, and the criticism was pretty harsh. Get through all of it and spoon feeding could seem barely a step away from force feeding. Shovelling gunk into a poor, subjugated baby and setting them up for a lifetime of eating issues. The book is also very clear that there is no scientific evidence to support spoon feeding. That's probably a fair point, until BLW came along I doubt it occurred to anyone to prove that spoon feeding was the way to go - there was no alternative. But if the book can ridicule puree for a lack of evidence, there must be some pretty hefty science behind BLW? Right?

I turned to the reference section of the book to check it out, I'll be honest I was already feeling a little doubtful but I expected to find a few scientific papers, hopefully even a review that analysed a whole group of studies. I  really hadn't expected how many references there would be.

Nine.

They are:

2 Dictionary's
4 Websites
1 Other book by the same author
1 Unpublished MSc thesis, by the same author
1 Scientific paper from 1928

For the whole 256 page book, which scorns spoon feeding for it's lack of evidence and suggests that mothers using the traditional technique could be harming their babies, there is only one proper, peer reviewed paper and in scientific terms it is ancient history. It may still have some valid information, but the way we eat now, the variety of food available and the ways we cook and store it, are all vastly different to what they were 86 years ago.

Spoon feeding; disappointingly not mess free


Now, before too many people start to get all defensive, I'm not saying there is anything wrong with BLW. I did it with my second child and would happily recommend it to friends who wanted to try. I just wish that the book had focused on the positives; How nice it is to eat with your baby and have both your hands for your own food, how much easier it is to only have one meal to prepare for the whole family and how much fun babies can have playing with new foods and lobbing them around the room. It could have given recipes and meal plans to help sleep deprived, befuddled parents. Instead it made a big deal about the lack of science behind the alternative and if you're going to do that,  you should have pretty damn good science for your own claims.

Dictionaries are not scientific evidence. Websites may be very informative or they may be complete nonsense. I could write here that:

I am a hummus expert - It has been scientifically proven that hummus is toxic and produced as part of a plot by our alien overlords to destroy the educated middle classes, so as to make it less likely that the clandestine alien takeover of the government will make it into a Guardian article.

Anyone else is now free to reference this blog as indisputable proof of the evils of chickpea based dips.

Referencing your own book and MSc isn't exactly convincing, I've not read them but I'm guessing the author is quite likely to agree with the author? I also have to wonder - if the MSc provides strong evidence that BLW is superior to puree, especially if it shows that puree is detrimental to health and development, then that is big news. So why wasn't it published? I've seen some pretty dreary, unimportant papers come out of MSc projects, this would certainly be worthy of a few pages in a major peer reviewed journal.

So where does this leave us? Is science behind baby led weaning or spoon feeding? Well, as far as I can tell, neither. There have now been a few studies comparing the two, and suggesting benefits for BLW but in every case it's quite possible that these benefits are down to other factors. BLW babies are, on average, far more likely to be exclusively breast fed for at least six months, to eat their meals with the rest of their family and to have parents who are well educated and fairly wealthy. All these things are likely to influence a child's subsequent diet and health. Most of the studies also rely on the parents opinion about their child's health and behaviour. So it's possible that the BLW devotees are expecting great benefits for their child so give more glowing responses than those spoon feeding parents who are less emotionally invested in their choice (for more detail on this see here).

So again, where does this leave us? It leaves us with two, perfectly valid, safe ways to wean our babies. Parents should be supported to do whatever works for them. In practise most people are probably doing a combination of the two anyway. But why must we have books that advocate one method by trashing the other? Mums can be pretty quick to judge each other, but we are lightning fast at feeling judged ourselves. Such a pile of negativity only feeds this. Surely what we really need is clear, non-judgemental advice about the best nutrition for our little ones? Not propaganda for the drawing of battle lines?

SBx


Thursday, 10 July 2014

London With A Four Year Old: The Natural History Museum And Beyond

For those who like them, sorry for the lack of science rants recently, if you're going to blog about people getting complicated stuff wrong you have to put in a lot of time making sure you aren't also talking out of your  own *ahem* and time has been in short supply of late.

Today's strike didn't really help with that, but rather than moaning about it I decided to make the best of my far too short notice surprise day of annual leave. Miss M was in nursery so I had a rare opportunity for a day out in our home city, with just my big girl and no school holiday crowds. 

For those with only tiny children - it is so liberating to have a day out with no buggy, changing bag or fixed meal and nap times. We headed off with just rain coats and an Oyster card (and Ana of course) and had a great day - here it is in photos.


Waiting for the train

Pulling faces in the train window



The Natural History Museum - amazing before you even get through the door.


Bring on the Dinos


Anamatronic T-Rex, I'll be honest, it was a little scary





Contemplating a blue whale tail


Lunch time treat in the museum restaurant


Watching the Guards at Buckingham Palace


After a long hunt we finally found one of the Pelicans in St James's Park


Then her buddies turned up too





Hourseguards Parade


Bloomin tourists


Finally worn out we "drive" the number 12 bus past Parliment, Big Ben and the London eye, all the way home.


Miss E was fast asleep by the time we past our old home 




SBx






Friday, 27 June 2014

5 Reasons Why Tech Firms Should Be Selling Wearables to Mums (Or should that be Moms?)

Not a Smart Watch

Google have just announced a range of new smart watches.  Devices, linked to your smartphone that sit on your wrist and let you know about incoming calls or messages and enable you to use apps and reject calls without even taking your phone out of your bag.

These newbies join some existing products with more thought to be on the way from Apple and microsoft in the near future. There's a lot of talk about "wearables" being the next big thing in consumer tech.

As a self declared gadget lover I'm kind of itching to get one of these things, but none of them has yet convinced me to stump up the (considerable) cost. The thing is, they are just all a bit big and blokey and I think the manufacturers are missing a trick here - where are the smart watches aimed at Mums?


Here are my top 5 reasons why someone should be making wearables for Mums:

1- We don't always have pockets

Most of these reasons really actually apply to all women, not just the mums. Blokes wear trousers all the time. Trousers have pockets. Women often don't have pockets or not ones that are big enough to hold a smart phone safely and without an unsightly bulge. So the phone goes in the bag and has to be dug out from amongst the nappies, spare clothes and unidentified sticky things, everytime it starts to buzz. It would be so much more convenient to leave the phone working away in your bag and peek at your messages on your wrist.


2- We need to know who's calling

There are times when your phone really needs to be on silent and it would be inappropriate to be seen fiddling with it. Unfortunately if you are a Mum there are pretty much no times when you don't want to be able to take that emergency call from school or nursery. A smart watch would be a great help here. No fumbling in your bag whispering apologies every five minutes, just glance at your wrist, realise it's another bloody sales call and send it off to voice mail with a flick of your finger.


3- We care about health

62% of those using fitness apps are women. The biggest group of these are aged 25-54. That's clearly going to include a heck of a lot of Mums. Most smart watches will integrate with fitness apps such as runkeeper or Samsung's own brand S-health system. Some also promise built in heart rate monitors, calorie trackers and sleep monitors that claim they could help you get a better nights rest - seriously - who'll want that more than Mums??


4- We're social

We blog, we tweet, we text etc. etc. etc. It's not unusual for me to be arranging a playdate while on my way to said playdate, pushing a buggy, dolling out snacks and trying to read texts and emails on my increasingly large smartphone. It would be so much easier if those texts just popped up on the buggy pushing arm!


5 -We like pretty things

We like them, we buy them and (lets be honest) we get other people to buy them for us. But the current offerings are going to look pretty big and clunky on a female wrist - come on designers let's have something for the geeky girls!

Some of the current offerings - picture from cnet.com 


I've started a Pinterest board with pictures of current or coming soon smartwatches - you can take a look here Currently I'd say the best looking least ugly are the Moto watch but that's not actually out yet and the Samsung Gear fit, but that has limited functions and only works with Samsung phones.

SBx
Yes, after trying to avoid them for fear of the inevitable time eating that would occur - I've now succumbed and joined Pinterest and Instagram - you can click on those links there to follow me (although there isn't much up there just yet, I'm sure there will be soon!)