Disco Knitter

Yes, I know, more boob propaganda. But hey, I have time on my hands…

Warning – long post about birth stuff. I use the word vagina, and talk about puking. Not for the weak of stomach, or the easily bored.

So. A million years ago, when Inigo was born, I wrote a basic summary about what happened. What you don’t really get from that summary is that a) when I took myself off to hospital, I was really worried that Inigo was already dead. That is why I didn’t tell anyone what was going on – I needed to get the information, and process it before I had to deal with anyone else’s issues. B) I was terrified. Scared out of my skull. I had my midwives with me, and that was the only thing that kept me from hysteria, but when the doctor (the only doctor that had ever mentioned a c/s to me during the pregnancy) showed up and started talking about surgery, I was a mess. C) The transition from being a healthy woman undergoing a normal life event (under the care of my wonderful midwives) to being an incubator for a very important patient, was jarring and disturbing. Yes, pregnancy and birth can be dangerous, and I am very glad for modern obstetric medicine, and I realise that this surgery almost certainly saved Inigo’s life. Yes, I am grateful to have my gorgeous healthy boy, but I think the situation could have been handled much, much better.

And then there was the surgery. Years ago, I had filmed in the morgue at Royal North Shore Hospital. There were dead bodies there. Some of the body bags were quite small. It was the sort of experience you don’t easily forget. And really truly – the operating theatres at Hornsby Hospital look just like the morgue at RNS. When you read in the news that Hornsby Hospital needs an upgrade, they aren’t kidding. Then they stuck a needle in my spine, while a twelve year old wardsman held my hands and looked into my eyes and told me it would be all right. I really appreciated that, but it would have helped a lot if he wasn’t twelve. And then Mark arrived. In a bright yellow shirt. And he tried really, really hard not to freak out.

Then I spewed. A lot. and because of the spinal block, I couldn’t lift my shoulders enough to spew into the bad they had given me. So I swallowed, and spewed, and swallowed, all over again. And while this was happening, I heard a cry, and someone said, “It’s a beautiful boy”, and I spewed, and said “I know that”, though how I knew he was beautiful I am not sure.

Then the anaesthetist gave me some Zofran, which instantly stopped the nausea, and somebody asked, “What are you going to call him?”, and I said, “Zofran is a lovely name for a boy”.

And then they brought him to me. Covered in green/brown poo, wrapped in a cotton candy hospital blanket and with a poxy acrylic yellow beanie on his head. That is an image that is burnt into my retinas, but thank goodness there are no pictures.

After a while, they stitched me up and when I was able to feel my toes I was able to see him. A bit. I couldn’t see his face, or get a good look, but I could stroke his skin, and hold his little hand. After a few hours I was taken back to the ward and he spent his first night alone. While I struggled with the pain. The following days were a roundabout, either in so much pain I could barely breathe, or so off my head that I couldn’t walk straight. And unfortunately this didn’t leave me in a good enough state to be able to be a good advocate for myself.

The weeks following were difficult, as it pretty much always is for new mums. Add to that the extraordinary pain from the caesar, and the horrors of learning to breastfeed after all the interventions we had been through, it wasn’t an ideal start for either of us. And we won’t talk about the horrible scarring and disfigurement.

Yes, what happened needed to happen. Yes, it saved Inigo’s life. Unquestionably, there was really nothing I could have done differently, and I am proud of myself for reacting when I needed to, and surviving the consequences. But would I willingly put myself in the hands of a scalpel happy doctor ever again?

No, not on your nellie. Whatever a nellie is.

So what follows is a whole pile of information about birth, what is normal, what is not, why vaginal birth is better for babies, and why I have chosen a homebirth. I’ve also thrown in a few random factoids just because inquiring minds want to know, and I am pretty much an open book about this stuff. Frankly, I wish I knew all this the first time, so I am happy to share the knowledge I have garnered over the years.

Vaginal birth better for babies – SMH

Perinatal Statistics, Australia, 2007

Robyn Dempsey, my midwife.

Homebirth Australia – the Rights and Responsibilities of the Pregnant Woman.

Babycentre.com.au article on homebirth.

Why it’s important to choose the right midwife.

What if you do end up needing another caesarian?

Well, that is a possibility – but my chance of having a normal birth are no lower than normal – about 20% for a normal first time mum (since I have never had a labour, I am considered to have the same risk as a first time pregnancy). And if I do have to transfer to hospital, I only a few minutes away from a very large hospital that has a neonatal intensive care ward, and my midwife will travel with me, and continue to be a support to me throughout the birth and afterwards. And I will insist on having skin to skin contact straight after birth, unless there is a clear medical indication that the baby needs attention.

But aren’t you “high risk” because of a previous caesarian?

Nope, see above. Also, risk profiles depend very much on your attitude to birth. Obstetricians are experts in the problems that can occur during labour, that is what they are looking out for, and equipped to deal with. Of course, this means that by choosing a private obstetrician, your chances of interventions during birth are much higher than if you are attended by midwives, even in a private hospital. So if I talked to an obstetrician, I would expect to hear that because I had a c/s in the past, it is foolhardy to insist on a vaginal birth this time around. Some Obs will “allow” a “trial” of labour, but as soon as things don’t go to a very rigid plan, you’re on the operating table again.

Aren’t you scared?

Terrified. But I won’t ever be doing this again. This is my last and only chance to experience a normal labour and birth. To feel what it is like to climb the mountain, and know what my body is capable of doing. I want my baby to be born without a hangover, I want her (we live in hope) to be on my chest as soon as she is born, and to find her own way to the breast, and to have her first breastfeed entirely under her own steam. I want to be surrounded only with people who truly have my best interests at heart, I want to be in comfortable surroundings, and in the arms of loved ones, in my home, my space, my sanctuary.

And research shows that homebirth has no added risks for mother and baby – it’s just as safe as hospital birth if you have a skilled attendant.

Why birth at home? What’s wrong with hospital?

For a start, Vaginal Birth After Caesarian (VBAC) rates for hospitals are very low. Depending on the hospital you choose, you have between 0% and 15% chance of a normal vaginal birth after a previous caesarian. Since I have had a thorough medical review from the team that were with me when Inigo was born, I have been assured that my chances of having a vaginal birth are about the same as any woman who has never been in labour before – about 80% (and that is assuming a hospital setting, where c/s rates are way higher than strictly necessary). So basically, by staying away from hospital, I am giving myself the best hope of a normal birth. And if I do need help, I am only 10 minutes away from a major hospital with a neonatal intensive care unit.

One other thing I’ll avoid by staying out of hospital – Hospital Acquired Infection (HAI).

Why are hospital VBAC rates so low if it is safe?

For a start, let’s talk due dates. A “due” date is just a random number that health professionals can use to guess at foetal maturity, readiness for birth, and “post mature survival”. Most hospitals have a policy of how far “overdue” they will “let” you get before they induce you. For Westmead, that is 10 days. But considering that a due date is just an arbitrary line in the sand, and most babies will naturally arrive up to three weeks either side of that date, it is a bit silly to have a policy around induction based on a due date, and not on the particular health circumstances of the particular mother baby pair. Obviously this policy is based on statistical analysis, and saves time and money, but it doesn’t suit my needs, and here’s why.

Most first babies are late. Three weeks “late” is not uncommon, and with good monitoring, there is no reason to hurry along a healthy pregnancy. Cervixes ripen, babies engage, mothers labour, all in their own good time. You can bet your arse, your baby hasn’t read the “policy”.

Induction is usually started with a prostaglandin gel, which artificially ripens the cervix and brings on labour in a more gradual and gentla way than the other alternative, which is Syntocin. Syntocin is like a sledgehammer, causing sudden and violent contractions that cascade and build without the slow buildup of natural labour, and makes the pain very sudden, and very hard to cope with. Very few women can tolerate the pain of this type of induction without an epidural.

Cutting open the uterus means that subsequent labours can cause the uterus to tear. Obviously, that is a nasty thing, and best avoided. Prostaglandin gel has a slightly elevated risk of uterine rupture, so as a woman wanting a VBAC, you won’t be offered the gel – it’s straight to the syntocin drip, and for most people, fast forward to the epidural.

OK, so what’s wrong with that? Well, it’s called the Cascade of Interventions. The increased pain of induction causes increased adrenalin, which, combined with the epidural, can stall labour, leading to the need for more drugs, a longer labour, an exhausted mother, and an increased likelihood of vacuum extraction, forceps, episiotomy, caesarian, and resuscitation. Failure to progress? Or failure to wait?

So as much as I realise that some interventions are necessary, some are just not necessary, and just lead to more. So if I can keep my foot off the carousel, I’m going to have much more control of the ride.

How much does it cost? Can you get a rebate from medicare or your private health fund?

My midwife charges $4400. This includes all antenatal care, birth, and post natal care up to 6 weeks. Currently there are no Medicare rebates available, though there are changes to Medicare coming in November which may cover some of the costs. I have yet to call my health fund to check if they offer rebates, apparently some do and some don’t.

But hey, we don’t really need a new plasma TV anyway, right?

Where will Inigo be when you are in labour?

That is a decision we will make much closer to the date, with Inigo’s best interests at heart. He is already excited about “his” baby, and if he really wants to be here, then I suppose that will be ok with me. I think at three though, it is much more likely that he will be better off with Nanna or Grandma, being spoilt and lavished with attention.

Will you be finding out the baby’s gender?

Absolutely. On the 9th of September I am booked in for a morphology scan (at 20 weeks). Hopefully, if she isn’t crossing her legs (like Inigo was at this point), we’ll find out. And yes, we’ll divulge. As a knitter, I always appreciate a heads up on colour palettes prior to the birth

What about other ante natal testing – you are old, you know!

I will be doing the triple test (a standard test for Downs Syndrome) in a few weeks time. If the results of that put us at heightened risk, I will consider doing a CVS.

Did you plan this baby?

“Plan” is a very strong word. We decided, the week before my 40th birthday, that we would try for another baby and see what happened. Well, what happened was we got pregnant straight away, and I started to feel ill even before I missed my period. I really feel for couples who a battling infertility, and if I could share mine, I totally would.

Inigo helped me put stamps on all the ABA bulletins I sent out today. The kid gets better and better.

Hoyden About Town commented on my recent link to 50 things you should know about feeding babies that the article needed “Weissingerising”. I absolutely agree, but it occurred to me that many people won’t know what we’re going on about.

Dianne Weissinger wrote a powerful article about the way we talk about breastfeeding – instead of saying that breastfeeding is “ideal”, we should be saying that breastfeeding is “normal”. Why? Because none of us see ourselves as ideal parents. “Trying Hard” parents, “Good Enough” parents maybe, but ideal, perfect, these concepts are too hard for most parents in the day to day reality of parenting, especially in the early days.

Also, as with any health message, it is better to talk about the risks of not breastfeeding than the benefits of breastfeeding. Can you imagine how many ex-smokers would still be smoking if the anti smoking campaigns were built around warm fuzzy images of healthy lungs instead of scary images of dead and diseased ones?

And we all now how I feel about patronising mothers by not telling them the truth about the risks of formula feeding….

I got this link in my inbox the other day. I rolled my eyes, and prepared to be bombarded with misinformation, and clicked the link.

And was amazed. Finally, a mainstream parenting website “telling it like it is” about baby feeding.

Go, read. If you’re interested, of course

Oh, and a PS. Yesterday was my first headache free day without medication. I still feel like crap, but touch wood, I’m on the mend. Thanks for all the well wishes!

There is a breastfeeding carnival on at the moment, a whole mob of people posting on the same subject and linking back to each other, and I thought, in my own little way, it would be nice to participate.

So, here we go, reasons why I love breastfeeding.

1. I am lazy.

2. Really, really lazy

That’s it. I mean, saving Inigo from asthma and allergies was also a motivator, and there are a brazillion other reasons why it’s worth persevering, but for me, laziness is a compelling factor.

No washing and sterilising bottles. No getting up in the middle of the night to warm the bottle. No trip to the supermarket at 9pm because we’ve run out. No scraping together loose change because we’ve run out on the day before payday. No finding three week old dregs under the sofa. No begging cafe staff for hot water for warming. No measuring. No pouring. No mixing. No hassling the kid to finish a bottle, or denying him if he wants more. No stressing about dental caries. No extra environmental burden. No worrying about traveling through Asia and access to clean water.

Now lots of people don’t breastfeed, and don’t worry about these things, or have different priorities, but this is my list. And as a breastfeeding woman who had to artificially feed her son for a few weeks, I feel that I am qualified to talk about this. I’m also a woman who struggled to get breastfeeding established for the first 11 weeks of my babies life, so it’s not like I think the whole thing is easy – but I definitely recognise the advantages of breast over bottle in my life.

Late Thursday afternoon I got the email I’ve been waiting for – I have been accepted as a volunteer Breastfeeding Counsellor for the Australian Breastfeeding Association. I spoke to the roster co-ordinator last night, and have been assigned my first helpline shift (2nd Friday of the month, starting in April). And this morning I logged in successfully – and logged out again quickly before I had to take a call. There is not enough caffeine in the world to make that first call easy.

So wish me luck, between now and the 9th of April I have to take lots of calls to get myself ready and comfortable enough to tackle an entire 4 hour shift on my own.

There is other (huge) news around the corner too, but I don’t want to say anything until it has been confirmed and I have more information. But needless to say, there are exciting times ahead!

Sad, but true.

The Lactation Resource Centre put on a conference/seminar every year for health professionals working in lactation, and every year there are exciting international guest speakers. Last year I saw the speakers as a webcast, but I really wanted to attend this year. Of course, registration fees were beyond the meager budget, so I was really excited when an opportunity came up to volunteer (and possibly sneak into the sessions).

And then a week passed, and another week, and I hadn’t heard from the organisers, so I figured I’d missed out. No friends Nigel once again.

But yesterday I was emailed a registration confirmation, and I’M IN!

I used to get excited about going to concerts and parties. Look what I am reduced to.

Link here.

It is common for women to believe that there will be a problem with their milk after a natural disaster, that the stress, or lack of adequate nutrition will make their milk “bad” or somehow unsuitable for their babies. In fact, the human body will provide milk for an infant even when the mother is malnourished.

And with the influx of foreign aid comes powdered infant formula (PIF, sometimes referred to as artificial baby milk or ABM), with the inference that this is better for the baby than what the mother is already providing.

And in a disaster, where there is a lack of clean water, giving a mother powdered infant formula often means she has to make it up with dirty water, leading not only to introducing infections to the infant, but by depriving her of breastmilk, she is also deprived of a natural defence against life threatening diseases.

In normal circumstances, breastfeeding needs to be protected. In a disaster, it is vital.

• Vanilla vodka makes a surprisingly good Gimlet (though my favoured version has equal parts vodka and lime juice – half cordial and half fresh
• Cooking with a child that hasn’t had a nap is quite like going to a teppanyaki restaurant. But much less fun
• When said child that says “I’m not going to sleep”, and I reply with “yes you are, you’re so tired that you’re almost dead”, and he picks up the chant “almost dead, almost dead”, it’s not exactly funny, it’s hysterical
• Parents and children have different needs, sometimes they intersect, sometimes they collide
• The bunny is now unofficially named Carrot. Inigo insists that his name is neither Vizzini or Tiberius, but it is most definitely Carrot. I have been told, but I am a recalcitrant type
• I am loving TransUrban beyond words. Yes, I know it’s unusual to profess undying love for a company that builds toll roads, but if it means that my husband is home BEFORE 5pm to deal with the feral offspring, then build me another M5
• According to Head Office, I have completed my last unit, and have now applied for a volunteer position with the Australian Breastfeeding Association. I now have a Certificate IV, I did it in under 12 months, and I have proved to myself that I have a small ability at this study thing. Now I just need to apply myself a bit more and do other interesting things. What next? Is there a diploma in World Domination?

The ABA has just released a new information leaflet about alcohol and breastmilk. Contrary to most of the information that is available to mothers (and often funded by formula companies that want to scare women into artificial feeding), this leaflet acknowledges that Australian women do like a drink, and gives guidelines for how to do it without harming your baby. For example, if you are a 75 Kg woman (I wish!), it takes 3hrs and 16 mins for two standard drinks to leave your bloodstream.

Not that I would ever encourage a woman to drink and feed – but you’re often better off doing that than drinking and giving artificail milk, and this information has been hidden for so long, this publication is a bit of a victory for common sense.

Cheers!*

*That is a virtual cheers from me – self imposed booze ban will be lifted over Christmas and New Year. Then we’ll check in with the liver and see how it’s coping!

There has been quite a bit of negative feedback in the media about the new breastfeeding strategy in the past few days. Many “opinion pieces” have attacked the strategy for “making mums feel guilty” for not breastfeeding.

This is a complete crock of shit.

Ask the mother of a child that was killed in a car accident before seatbelt laws if she feels guilty for not knowing about seat belts. Or a man dying of lung cancer if he feels guilty for smoking. The melanoma patient that loved the beach.

We make our decisions based on the evidence that is available at the time. Sometimes new informations has an impact on us, and we change our behavior. Sometimes we get the health message and decide to ignore it, like I did with soft cheese while I was pregnant – I did some research and found that there had been one case of listeria in pregnancy in Australia in the past two decades, and I decided to take the risk.

I would never tell another woman what to do, but I think it is fair to give them the information so that she can make up her own mind. It is my opinion that most mothers think a lot about what is best for their babies, and most mothers make conservative choices. And yet many women choose to artificially feed their babies. If I was doing a PHD in anthropology I think I would choose study this question. Since I’m not, I have to guess that most women don’t know how risky it is not to breastfeed their babies.

Of course, there are some women who can’t breastfeed. Some women have to have treatment that is incompatible with breastfeeding, or surgery, or there are other, valid reasons for not breastfeeding. Or they simply choose not to, and that is ok.

What is not OK with me is hiding the facts about the risks of artificial feeding in order to spare the feelings of a non-breastfeeding woman.

Below is what I wrote as a comment to a newspaper article that I read today – a new mum that “couldn’t” breastfeed because of poor advice, attacking the ABA, the one organisation that could have helped her if she had chosen to reach out.

—–

The new strategy is about supporting new mums, so they don’t get this stupid advice. If Rebecca had good advice and support when she was trying to get breastfeeding established (or even before the baby was born), her story might have been a lot different.

I too struggled to get breastfeeding established, and suffered for nearly three months. Before my baby was born, I attended a Breastfeeding Education Class run by the Australian Breastfeeding Association, and when things got hard, I turned to them for support and advice. My baby is just about to turn two, and he is still breastfeeding. It is my intention to follow World Health Organisation guidelines, and feed him at least until his second birthday.

This new strategy has looked at the “hard evidence”, and has come to the conclusion that formula use places an unnecessary strain on health services. Artificially fed babies do have worse health outcomes (and so do their mothers) – so of course the government wants to encourage and support women to breastfeed.

And if you’re after scientific evidence that formula feeding carries risks, read this article – www.onemillioncampaign.org/doc/RisksofFormulaFeeding.pdf The information is easy to read, but each point is referenced with the research papers so you can look up the results for yourself.

As for the ABA using emotive language, that is a no brainer. In my opinion, saying that breastmilk is a gift that a mother can give her baby is much nicer than saying giving formula to your baby increases his risk of diabetes, obesity, asthma, SIDS, hospitalisation for upper respiratory illness, childhood cancer, reduced cognitive development, allergies, infection from contaminated formula, altered occlusion, nutrient deficiency, etc, etc.

It is interesting to note that Cuba, which has strong government support for breastfeeding, has a lower infant mortality rate than the USA, where breastfeeding rates are even lower than they are in Australia. Breastfeeding saves lives, and I think that it is time we stopped pretending that artificial feeding is “just as good”. Hiding these facts from women who are making a choice to artificially feed their babies is patronising, and dangerous.

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That was Inigo’s post for yesterday, but silly me forgot to post it.

I was at an ABA conference (training) all weekend, so I neglected to blog except for the scheduled posts. On the upside, I did get signed off on 2 and a half units, so it was a really worthwhile weekend. Not to mention catching up with a whole lot of amazing and inspiring women! I had been feeling really down about my training, and even considered giving up.

But now I am re-energised (emotionally, physically I am still a wreck), and keen to power along to the finish line

The World Health Organisation International Code of Marketing of Breast-milk Substitutes, article 5.5 prohibits seeking direct and indirect contact with mothers of infants and young children, that is children up to 3 years of age. UNICEF has previously stated that: “any form of contact with mothers of children under 3 years is prohibited, irrespective of the motivation behind the contact.”

If you get a free sample of an artificial baby milk, or are invited to join a branded “club” (as is being widely advertised with prize giveaways at the moment), you are witnessing a violation of an international code that is designed to save lives.

The APMAIF is a regulatory body that is designed to oversee the marketing of artificial baby milks in Australia. If you see a breach of the code, you should report it to the APMAIF, and they should follow up and stop the breach, and punish the offender.

But the APMAIF is an industry body. It is made up of all the companies themselves, and they have absolutely no desire to follow up on breaches of the code. The lunatics have taken over they asylum, and are handing out happy pills.

So next time you see formula on special, or grab a parenting magazine with a formula sample in it, complain to your local member. The APMAIF won’t do anything about it.

From Hoyden About Town. Which, incidentally, everyone should read.

It makes you smarter.

Or does that only work on me?

There’s been a bit of hoo ha on the internets recently about Nestle, (see here and here for some background), and I was reminded of something I saw in an Indonesian supermarket.

Yup – chocolate milk, marketed for infants, with a free sippy cup.

The government has commissioned a research company to do research on a national breastfeeding strategy. Now is your chance to have your say.  The survey closes on the 14th, so you don’t have much time!

If you can’t be bothered reading the link – email the answers to the following questions to nbs@allenconsult.com.au

• Do you think that support and the promotion of breastfeeding should be provided consistently to all mothers and women across Australia?
• In your experience, did promotion of breastfeeding while you (or your partner) was pregnant encourage starting and/or continuing breastfeeding? What things seemed to help the most? Why?
• Do you think that there is enough breastfeeding support provided to new mothers?
• Have you or your partner ever sought or been referred to a breastfeeding support service or lactation consultant? What sort of service? Did it make a difference in you/your partner’s ability to continue breastfeeding?
• How do you think breastfeeding promotion and / or support could be better provided?
• Do you think that information such as the rates of breastfeeding (number of babies breastfed as a percentage of the total population of babies of particular ages) and other similar information should be collected on a national level?

At the risk of sounding like a breast feeding single issue party, I’m posting this to make myself feel better about all the formula advertising I saw at the baby expo last week while I was there volunteering for the Australian Breastfeeding Association. Watching pregnant women walking around with tins of formula was dispiriting, I think it’s important to keep this information circulating. If you know a pregnant woman, your support in her breastfeeding relationship is important, especially if you are her partner, or her close family. This is not about bullying people into doing something they don’t want to do – it’s about supporting them if they do want to do it.

Blatantly stolen from PhD in Parenting, much more info here.

Benefits to the child

• Acute otitis media ( middle ear infections): Babies that were ever breastfed had a 23 percent lower incidence of acute otitis media than exclusively formula fed babies.
• Atopic dermatitis (type of eczema): In families with a history of atopy, exclusive breastfeeding for at least 3 months was found to have a 42 percent reduction in atopic dermatitis compared with breastfeeding for less than 3 months.
• Gastrointestinal infections: Infants who were breastfeeding had a 64 percent reduction in the risk of non-specific
• Lower respiratory tract diseases: There is a 72 percent reduction in the risk of hospitalization due to lower respiratory tract diseases in infants less than 1 year of age who were exclusively breastfed for 4 months or more.
• Asthma: Breastfeeding for at least 3 months was associated with a 27 percent reduction in the risk of asthma for those without a family history of asthma and a 40 percent reduction for those with a family history of asthma.
• Type 1 Diabetes: Breastfeeding for at least 3 months results in between a 19 and 27 percent reduction in incidence of childhood Type 1 Diabetes compared with breastfeeding for less than 3 months (findings confirmed through multiple studies, but some cause for caution in interpreting results).
• Type 2 Diabetes: Found a 39 percent reduction in risk of Type 2 diabetes later in life for people that were breastfed as infants (some cause for caution in interpreting results).
• Childhood Leukemia: Breastfeeding for at least 6 months associated with 19 percent decrease in risk of childhood acute lymphocytic leukemia and a 15 percent decrease in the risk of acute myelogenous leukemia.
• Sudden Infant Death Syndrome (SIDS): The meta-analysis found that breastfeeding was associated with a 36 percent reduction in the risk of SIDS compared to not breastfeeding. Another study completed since the meta-anlaysis was done found a 50 percent reduction in the risk of SIDS as a result of breastfeeding.

PS. Daisy is sitting closer to me than he has in months, purring like a lawnmower. I am sure he knows something…