Saturday 30 July 2011

23 Week Babies - Revisited

I have blogged about this before, after the screening of Adam Wishart's documentary "The Price of Life - 23 Week Babies". If you missed it, you can view it on YouTube. However after some flutters on Twitter this week, I wanted to revisit this topic and clarify the situation in the UK.

In the press this week, there has been an article about baby Jacob McMahon a little boy born at 23 weeks, sadly his sister passed away several days before, however after a 5 month stay in hospital, Jack is now home. This story has been picked up by the US Right to Life movement, and been interpreted in somewhat interesting ways, an example is this article tweeted by a fellow preemie mum today.

As in the US, in the UK babies born before 23 weeks are assessed on a case by case basis. Jacob is undoubtedly a special little boy he is not unique, many babies have been saved below the "threshold" of 24 weeks. I can understand the Right to Life movements desire to utilise these stories, as the current abortion limit is 24 weeks in the UK, so there argument is surely that if babies can survive if born before this threshold then termination is wrong.

I dislike the linking of the premature baby debate to the termination debate and I see them as two very seperate issues. Just to clarify, I have a completely on the fence attitude to termination. In a perfect world, all terminations would be banned, babies would be born to happy parents, who want and are ready for a baby, and no baby would be poorly in the womb. But life isn't like that. I would never judge anyone for having a termination, each of us has to do what our own heart and conscience tell us to do.

So to clarify, babies born before 24 weeks can be saved in the UK. It is, somewhat, a lottery, in this case a term I also dislike. It is a lottery because it depends on what sort of hospital you present to. If you present to a hospital without a level 3 NICU then its unlikely that they will be able to save your baby born before 24 weeks, it doesn't mean they won't try, but they may not do if they feel that treatment will be futile.

There is more debate about this in the UK than in the US, and that is for one very good reason. We all pay for the treatment of these tiny babies, our medical system is public, its not down to individual insurance companies or hospitals, its down to the NHS to determine what level of support they are prepared to provide. 

I feel that the Right to Life people, at times, miss the point. Treatment is not without cost. Doctors are not cruel, making arbitrary rules. They are governed by a number of factors, but first and foremost "first do no harm".  There is a reason they give babies morphine, treatment is painful. And sometimes, its futile. Babies can be born in horrendous circumstances, already having infections, or having underlying medical conditions that have not yet been diagnosed. I am not ashamed to say that I asked whether we should let Joseph slip away. I was concerned about the cost to him personally of undergoing treatment. In our case it was clear cut, delivery had been done in a timely way, and he needed some interventions, however they were minimal compared to other babies. Am I sorry I asked that question, no I am  not, because I felt, as his mother, I had to consider his needs, all I wanted was my baby to be well, and to not suffer.

I do think it is healthy and right that we debate these issues. However as well as love and compassion, we need to debate with truth and with integrity.

Friday 29 July 2011

Why I Blog - And What I Want to Be When I Grow Up

The reason I blog is I love to write. I've always loved writing. I've never been great at fiction, I remember one of my teachers in high school telling me that my short stories were more like scripts for a soap opera (I must have missed my calling). My great love has always been non-fiction.

The first non fiction I remember writing is a rather awesome piece about the wide combed shearers dispute in Australia in the 1980's. I was 9. It was just really interesting the competing views of the traditional shearers and the newer style shearers who wanted change. It was about tradition, and animal welfare but also money.

I was hoping to go into law, initially, but my work experience entirely put me off. My favourite moment on work experience at the age of 15 was saying to the solicitor who was babysitting me "you can't let your client appear like that". And he just looked at me like I was a piece of manure and said "look not everyone dresses up in a suit its fine". And I said again "really, he can't appear like that". He looked again. The guy was on a marijuana charge (in the days when it was more serious than now) and had a t-shirt with a stoned koala on it. The solicitor was horrified. I made the guy take it off, turn it around so it was back to front, and stick my cardigan on. He got off. It was then I realised I was more a practical person, and should look for another career.

My revised plan was industrial relations, I wanted to be a union advocate. I did work experience for the Tasmanian Office of Industrial Relations, it was a fabulous experience and I was given a lot of responsibility, taking minutes, meeting top players in unions in Tasmania, I was hooked. So I embarked on a degree in Human Resources and Industrial Relations. But I was a very organic, round shape in an extremely rigid square hole. There I was in tie dye trousers and long flowing hair learning about tedious stuff. I had to pass 24 subjects, and just could not, for the life of me, pass the last one. I failed Business Statistics 3 times. I gave up.

I got a distinction for my thesis, my other subjects that relied on the written word I did fine, but just could not manage business statistics. It just was not my thing. But I soldiered on, determined to work in industrial relations. I worked as a carer in a group home, and became an shop steward. I did really well, and like to think I was well respected, and as a team, we got some great things accomplished. But I just could not break into the sector, and then, then world changed. Australia took a massive step to the right and the work just went.

I've drifted in life, and once I found myself at home, being a mum, I missed using my brain, so my blog has become my outlet for writing. And I love blogging. Would I love to do more, yes. I'd love to get into writing articles. I find writing interesting and therapeutic and I love sharing ideas.

I still haven't decided what to do with my future, and feel a bit stuck. I'm thinking of returning to University to study Paediatric Nursing but a little voice in my head is not so sure.

I still, at the grand old age of 39and 1/4 I still do not know what I want to be when I grow up.

Thursday 28 July 2011

Preventing Maternal Deaths

This isn't an easy topic to write about, but following Panorama's "One Born Every 40 Seconds" shown on BBC1 on Monday 25th July, I felt it was something I wanted to explore further. I can understand if you do not wish to read further, its not pleasant subject matter. However, what concerned me, is that the documentary only focussed on one possible cause of these deaths, and that is the failure of the NHS to provide adequate midwifery resources. I feel that this is only part of the story, and wanted to look at the role of patient education and awareness. In this post I only focus on maternal death, not the death of the baby, that is another post for another day.

The bulk of the source information that Panorama used was from the Saving Mother's Lives report - reviewing maternal deaths 2006-2008.* You can find the link to the report in its entirety here, it makes for sobering reading. I am just a mum, I'm not a researcher, or a doctor or a clinician. But I am passionate about awareness and education. Scaremongering is one thing, but empowerment is another. And what worried me about the Panorama reporting is that it didn't empower, it frightened. What can a pregnant woman do to ensure she is safe in pregnancy and childbirth? She can educate and empower herself, and her partner.

I think its important to note that the actual numbers we are talking about are very small, in the three year period the report covers, 261 women died in pregnancy. Now this figure covers direct and indirect maternal deaths, and for the purposes of this discussion the number I am interested in is the direct maternal deaths, 107 in total, of conditions or situations that only arose due to pregnancy. I think the indirect number is significant too and may be a subject for another post.

The main cause of direct maternal death is sepsis/genital tract infection. I had no idea that this was the case. The report talks about the link between sore throat and genital tract infection. How many women know, that if they are pregnant and have a sore throat, they should consult their doctor or midwife. I certainly didn't. The second main cause is pre-eclampsia/eclampsia, haemorrhage is way down the list at number 6.

Until I was pregnant, I had very little awareness of pre-eclampsia. I knew, from my job authorising procedures for a medical insurer, that pre-eclampsia necessitates swift delivery usually be caesarean section, but didn't really know any more than that. I certainly did not expect to get it, and I did not think it could be fatal, not really. But its very clear that pre-eclampsia/eclampsia is killing women in England in the 21st century.

It's important to remember that the numbers are small,  19 died in the three year period as a result of pre-eclampsia/eclampsia and as its a very common condition, its clear that it is managed, in the most part, very well. It is also clear that initiatives in this area are working. The number of women dying of these conditions in the reporting periods of 1985-87 and 1988-1990 was 27 in both periods, so clearly we are making progress.

Alarmingly though, the rate of women dying as a result of sepsis (and one of the cases featured in last nights programme was sepsis) is increasing. I certainly didn't realise that infection can kill women in pregnancy or shortly after delivery, and I am not sure I would have given a sore throat a second thought. I think, alarmingly, One of the ten recommendations of the report is that there should be more education about genital tract infection and sepsis. I would have even shrugged off a urinary tract infection as being annoying, not necessarily a source of danger. And I do not think I am alone in this.

What is clear from the report is the role that antenatal care plays in preventing maternal death. A significant number of the mortalities were women who either did not have any antenatal care, or sought antenatal care late in their pregnancies.I think also, whilst this doesn't come out in the report, is the quality of antenatal care. Surely a shortage of hospital midwives equates to a shortage of community midwives. I think laying the blame at the door of midwives in particular is wrong. The situation is a lot more complex than that.

I remain convinced that education, awareness and empowerment is important. Being aware of any pre existing conditions and ensuring you get proper consultant input is essential. Being aware of signs and symptoms of consitions like sepsis and pre-eclampsia is vital. Listen to your body, and have your voice heard, don't allow yourself to be fobbed off. Follow things up yourself, if you have been referred and not heard anything, ring - all hospitals in England have a PALS (patient advisory liaison) service, use it.

In a busy, and at times understaffed system being aware and assertive is important.

*Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal
deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):1–203.

Wednesday 27 July 2011

Ten Things I Love About You

Today's post is a linky hosted by the lovely Aimee at Mother on Mother Earth , sharing ten things we love about our little ones.

1. I love the way you play. You don't need toys or fancy things. You love stones, dirt, water, pens, paper. You can play anywhere anyhow, and I love that about you.

2. I love your compassion and your empathy. One of my favourite moments in Australia was when a young lady was crying at the airport and you went and cuddled her legs and smiled at her.

3. I love your smile, the way you light up a room and make everyone feel happy.

4. I love your bravery. Not only when you were in hospital for all that time, but you have had to have quite a few tests and things, and you always face them with a smile.

5. I love your sense of humour. You have an amazing sense of comic timing, its like living with Peter Kay!

6. I love your words. Being able to communicate with you is a joy, and I love hearing you speak. It brings such joy to me.

7. I love your cuddles. When you stand up in the cot at bed time, put your arms out and say "cuggle Mummy" it's just so lovely. And the tongue kisses!

8. I love the way you eat. Especially spaghetti and linguine. It's a joy to me to watch you devour your food.

9. I love our time together, going new places, discovering new things, I love seeing the world through your eyes.

10. I love the way you sleep, all curled up, sometimes with a little smile, you are just so cute. And I love the way you sleep 15 hours a day, even if I do worry sometimes!

Tuesday 26 July 2011

Australia - Things I miss

My family - It is first and foremost. I miss my mum and dad, and my sister, and my nieces and nephew. I feel sad for Joseph that he will never have the close extended family relationship that we had as children. When I go over, its so intense, we have to pack a lot in, and its hard. I miss the natural relationship of living relatively nearby.

The bush - In Tasmania, the bush is never far away, what you would call the forest. The Australian bush smells of Eucalyptus, the oil that I burn isn't the same. Where we used to live, in Stubbins, there was a house with a blue gum in the front yard. I would stand in front of it and smell it, sometimes I'd grab a leaf and tuck it in Joseph's pram. The smell of home.

The bird song - Ive heard it said that English birds sing and Australian birds squawk, but I don't think that's true. I miss the sound of the birds, even our magpies are different. I love the sound of kookaburras, particularly in the morning.

The food - What I would give for flathead! I miss the fish, scallops and crayfish. I miss the fruit and vegetables, there is no imported fruit and vegetables, unlike here, beans from Kenya, and apples from South Africa. The downside of this is that if there is a local problem like cyclones in Queensland then the cost of fruit like bananas, absolutely sky rockets.

Branded food - I miss familiar packets in the supermarket, even now I think in Aussie brands, Arnott's biscuits, Coon cheese, Cripp's bread. I miss Aussie chocolate, like my beloved Cherry Ripes, everyone is under instruction to bring some back for me if they travel to Oz.

Eating out - Eating out is different in Australia, everywhere produces good quality food. I really miss going out for breakfast. In England its nearly always just a variation on a Full English (not that there is anything wrong with that) but going out for breakfast or brunch is a big deal in Australia and there's always a really good choice of food. I miss lunch too, the different breads, and the variety of salads, it is just so different.

Music - I find it hard to keep in touch with Aussie music, and I really miss it. I miss the the songs I grew up with coming on the radio. I miss the rock, but also the folk music and the country music I grew up with. Sometimes putting on a cd makes me so sad, and reminds me how far away I am. There is so much more to Aussie music than INXS, Kylie Minogue and Crowded House.

Craft - I think there's a number of factors, but more Australians seem to craft than people here. I think given the work life balance is better, people have more time. You can source good fabrics and things here, but it is much harder than back home. I miss our big craft shops like Spotlight and Lincraft, and I always stock up when I go home.

The accent, slang and jocularity - Aussies will talk to anyone, they are open and friendly. I love the accent, and I really miss it. I am always accent spotting, and gladly launch on anyone I hear, and have a natter. I love talking to people from back home, but its very rare that I find a Tasmanian. When Joseph and I arrived in Australia this time, we got into a lovely conversation at the airport bus station, and nattered about football with the bus drivers. One even gave us a dollar to buy Joseph an icecream!

Football - I dearly miss Australian Rules my beloved Richmond Tigers. I miss watcing the football with people who care, watching it at home with my soccer loving husband just isn't the same. I miss the banter, the tradition and the hot men! Fancy playing a game with a ball in long shorts with long sleeves, what is the point? And running around for 90 minutes for a zero score, what's that about?

The light - notice I haven't said weather, I am not sure whether I have acclimatised, but I don't miss the weather back home, (which is much easier to say in July than it is in December) but I do miss the light. I can't describe it, its just different.

The water - In Tasmania you are never far from the sea, and I miss being close to the sea and the beach, the salt water smell.

Current affairs - I miss news reporting and current affairs shows like 4 Corners. Aussies have an inquistivenss and honesty that is very different to here. My favourite show is Australian Story, thank heavens for the internet, that is one show I can catch up on.

What I don't miss:-
Clothes shopping. Fat chicks are much better catered for in the UK. There is more choice, the fat clothes are cheaper, and they are much more fashionable.
Supermarkets. When I first went to Tesco, I was amazed. Fancy being able to buy clothes, tvs, toys in a supermarket. And the ready meals. Although I rarely buy them, at times they are handy!
Public transport. I find England amazing, so easy to get around, and I have a lot more mobility than I did back home.

Monday 25 July 2011

Farewell to Fairfield

One cold day in 2004 I was walking through the centre of Bury and came across a large protest. People were milling about asking for signatures. The petitions were to try to save the local hospital's maternity unit, including special care baby unit. That hospital was Fairfield. Back in 2004 I hadn't met my husband. I was pretty much resigned to not having a baby, ever, so I certainly didn't think I would ever need the maternity unit and much less the special care baby unit. But, I felt it was essential to have local services so signed the peition.

At booking with the midwife I was given the choice of two hospitals, either Fairfield General or Salford Royal. Salford would require 1 bus and two trams to get to and fro, so I chose Bury, just two buses, and only 15 minutes by car.

This week, after a protracted fight, and several stays of execution the decision was made an handed down. Our hospital's maternity unit and special care baby unit will close in March 2012.

I am bereft. I think there are several reasons I am so upset about it. First and foremost, its sentimental. My son was born in that hospital, all my photos and videos were taken in that hospital. It was his home, and I love that hospital. My life was saved in that maternity unit.

I am scared for local women. The newspaper article is misleading. There are not 4 hospitals with in 7 miles, there are two, the other two options are birth centres, which are not suitable for all pregnant women. I would not, even if I'd gone to term, been a candidate for a birthing unit.

I am scared that had we had to travel further, whether I would have got to hospital in a timesly manner. When we rang at 3 in the morning we were urged to go straight in. Had we had to travel 30 minutes or so, would we have done it? I'm not sure. And it worries me.

And then the travel. All the article and the comments afterwards concentrate on are those straight forward births. One in nine babies are born prematurely, which means one in nine families, potentially have the wrench of being away from their babies. From many parts of Bury to get to either of the two hospitals is a journey that will require at least 2 and usually 3 buses, at a cost of £5 a day. That's a lot to ask, in my opinion.

And then there is the aftercare. Our unit was small, everyone knew us, I never felt scared to ring the unit after Joseph's discharge to ask silly questions, the staff at the local unit are always so happy to see us. It's a caring family unit, the care is second to none.

I can see a little of the reasoning of the NHS trust, to consoldiate services and modernise them, however, I think centralising is wrong, and has missed the mark. Local services are essential.

The fight isn't over, it continues, but I think the writing is well and truly on the wall.

Saturday 23 July 2011

How to Deal with Toddler Tantrums

Tantrum in B&W
Image - Tantrum in B & W - majorvols

To give you some background, I used to work as a carer for adults and children with complex needs and we did a lot of work around behaviour management. The training I have had has really helped me to manage Joseph. I am not perfect, by any means.

Thank you Joseph, for providing yesterday's post. As you can see toddlers are well versed in conducting performance tantrums for maximum effect, here are my tips.

It's not about you - Tantrums are a phase, they are a normal part of development and it is not a reflection on you as a parent. Don't take them personally. And don't listen when old people say to each other, in a voice loud enough for you to hear "oh that mother has no idea". Neither did they when they were in your situation. I don't care what Jo Frost or anyone else says, you can't necessarily control a tantrum, you just have to ride it out.

Take a step back - Before you start trying to do any thing, just take a step back and be objective. If the child is safe, sometimes its best just to let it run its course. I usually smile goofily, or look at something with interest, keeping an eye on Joseph at all times. Sometimes by trying to intervene, you actually prolong it, by becoming involved. A performer performs for an audience. Take the audience away, and suddenly, the performer loses his credibility and his reason for performing.

Prevention is better than cure - Sometimes, there is a pattern to tantrums. I know that Joseph is more likely to have a tantrum in public if he is over tired. As a result I will try to schedule activities for times when I know he will be well rested. Joseph also has tantrums if he is over stimulated. One of our regular activities is shopping at Bury Market. When we first arrive I go straight to Greenhalgh's and get a gingerbread dinosaur. It's not bribery, as I give it to him before a tantrum, and he happily munches on that. A dinosaur takes about 30 minutes for him to demolish. It is a bit like Supermarket Sweep, but I can get my shopping done before it gets entirely consumed. Before I started doing this, our shopping trips were nightmarish. Bury is so busy, that toddler tantrums suddenly become a sideshow. I have considered dropping an upturned hat and taking donations.

Don't smack - I don't smack anyway, but from what I have observed, smacking makes a tantrum ten times worse, because you have given the child a legitimate reason to kick off even further. It's tempting, because you just want the performance to stop, but smacking I think is just not the answer at all for tantrums.

Keep your voice and demeanor calm - Nothing is more annoying than an audience who refuses to participate. If you keep calm and try to just carry on and ignore the tantrum, it may help to shorten its course. It may not, however, but shouting back, or getting upset is playing right into the hands of the performance artist.

Empathise - To be honest, most of the time when Joseph throws a tantrum, I can relate and empathise. If he's tired, especially if something has taken ten times longer than it should (long queues or delays in transport) then I can see why he just wants to let fly. Often just saying "yes I feel annoyed and frustrated too" is enough to make you feel in touch, and you can deal with the problem together. It's not about the toddler understanding you, it's about you understanding them.

Dealing with onlookers - To be honest, to me the worst thing about tantrums is dealing with onlookers. I get really cross, because a lot of old people come across as judgemental. Either this phase is really short, or the trauma of toddlerhood is so deep, you obviously must just forget that once, you were that soldier, battling with a budding performance artist. It winds me up. I try to ignore the onlookers, but sometimes, you just have to say "you are really not helping, butt out". Because Joseph is small a lot of people think he is younger than he is, and that there really is something wrong. That's the worst. I'd rather be called a useless bad mother than have someone coo over Joseph saying "oh what's wrong darling?" I had a classic at baby group. Joseph hates pack up time. The hall has wooden floors. Joseph threw himself back, then checking there was nothing behind him, banged his head for maximum effect. It was very loud. One of the childminders, acting on instinct, picked him up and gave him a huge snuggle. I swear Joseph winked at me. I sat there stony faced. The childminder immediately twigged. She said to me "I have just undermined you haven't I, I am so so sorry!" I didn't mind really, and it did stop the tantrum!

Tantrums are just a normal part of life with a toddler, and you are not the first parent who just wanted to step in a tardis and be whisked away, we've all been there.

Friday 22 July 2011

10 Tips to Performing the Perfect Toddler Tantrum

Today’s post is provided by Joseph, aged 2 and 2 months. He has provided a very thoughtful insight into the explosive art of tantrum throwing. Here are his top tips.

Thanks mum. I wanted to write this because I feel that the art of tantrum throwing is greatly misunderstood, and very few people appreciate the thought and care that goes into these great pieces of performance art. Just a note in the following I refer to Mummy, however please do not limit your tantrums to mummy, any caregiver will do.  Here are my top tips. 

Practice – A true performance artist understands the importance of rehearsal. Regular practice at home is essential. You can start small, just in front of mum is a good plan, and to start with don’t allow anyone else to see these practice runs. This will enable you to retain an air of mystery. Everyone else sees a cute wide eyed toddler, and only one person is truly aware of your performance capabilities.

Surprise – I cannot overestimate this enough. It’s no good whinging all day and then performing  a massive tantrum and expecting to get anywhere. No the best tantrums are undertaken when you have been a delight all day, and then suddenly, like a Michael Jackson breakdance, there you go, performing a masterpiece to the delight and surprise of all around you.

Words – Words are not essential, however if you do know a word, repeat it, regularly, at volume. You know, it doesn’t even have to be a real word, and in fact, a word that sounds like a regular word (or even better could resemble 3 or 4 normal words) is even better, as not only do you have pester and annoyance power, people might actually think you have something valid to say, and fuss over you. My favourites are groups of old ladies “oh he might be hungry. Have you tried a chocolate? What about a cuddle? Oh he’s tired.”  Mummy’s favourite of mine is when I screamed “apple” all around the supermarket and an old lady said “why don’t you give him a biscuit?” Priceless.  I didn’t even mind mummy’s attention going to the old lady for a death stare and away from me, but only for a second!

Location and Timing – you have some options with location. You can pick a crowded one, or, equally effective is an intimate one, the bus stop, a short queue, on a train carriage. Timing is also crucial. If you think you have got your timing off, pull back, and wait a little longer. A “warm up” often increases the effect of the “real one” later.

Just a note for you fellow ex premature baby superstars, such as myself, conducting your performance in front of people aware of your "miracle birth" is priceless. Firstly, they think everything you do is marvellous, hence allowing you to perform to your  fullest potential. Also, they are usually so busy trying to engage your mummy in conversation, you can just let yourself get lost in the awesomeness of your performance. You'll even get praise "oh he's so normal isn't he? Aren't his lungs strong? Oh its so wonderful to see him doing normal things". So you completely get away with it, and you make mummy look really really bad if she tries to stop you. Genius.

Body Positioning – arguably, the public tantrum is more effective if you are mobile, walking holding hands. Suddenly going stiff and throwing yourself on the ground is a time worn classic for a good reason. It’s loud and it’s embarrassing. However being in a pram can be just as effective, however as well as volume it is essential you work on your positioning, otherwise your mummy can just wheel you out of danger. No you must make your body stiff, then flop forward, rocking is a great way of maintaining the rage. Not only does it make you difficult to manage, you are in danger of tipping the chair over, so, crucially, your mummy must either go behind you, thus losing eye contact, or go in front of you, risking injury.

Volume – Yes, there are times when maximum decibels are important, especially in the crowded tantrum performance. However, varying your volume and tone can be wonderful. If you suddenly go quiet your mummy will listen, bending close, then you can let rip again. 

Props – Use your tools. Pram toys, that banana given to you to placate you, your water cup, your pram, your clothes, all become fair game to the tantrum performance artist. It is up to you to use these in the most effective manner possible.

Behaviour modification – The modern toddler is up against it. These mummies talk to one another, sometimes on the black box thing, sometimes over coffee. They also read books. This Supernanny woman thinks she gets it. It is up to you, my toddler friend, to undermine all attempts at “behaviour modification”.

Ending the performance – There is no right way to end a tantrum, and you have several options. The gentle petering out is one of them, and then you have the option of continuing the performance if required. Responding to your mummy’s attempts an ending one is a good idea. You can accept a bribe, you can suddenly stop and go all smiles, or you can go to sleep. If your tantrum has been one to get something you want, you could go all out and start another for something else. What is vital is that you choose different endings. If the outcome is always the same, then mummy might start to cotton on to it. Do not make that error.

About the mummy - Tantrums are all about you, your performance techniques, your skill as an artiste. Don’t feel bad about the mummy. She was a toddler once too, and is well-versed in the art of tantrum throwing, she’s just forgotten how. Hopefully.

Thursday 21 July 2011


Dear Joseph,

The 21st July will always be an important date to me, even more important than your EDD (estimated due date). I don't think a year will go by that I don't reminisce about this day, in 2009.

I had roomed in with you, and the morning was so busy. You lay in your crib, very content, you had a feed at around 11, and then dear J, our ward sister came in to speak to me. She explained how thrilled she was with both you and I, and how well you had done. She explained about the four medications you would need to have daily, and she explained about your milk, and how to organise prescriptions. It was clear that she was emotional, you were one of the smallest babies to have been accommodated on that unit from the moment of your birth until the day of discharge. She was immensely proud of you.

Finally at around 3pm we were allowed to leave. Your dad drove so carefully and slowly, and we finally got you back to our little flat in Stubbins. We opened the door and your dad took you around the flat and told you all about where we lived. We put you down, and Atticus the cat, came up and sniffed. It was then we realised that you were actually very very small! Atticus was twice your size!

I don't remember much of that day. I remember my friend Jenni popping around with some baby things, I don't remember what we ate. I remember the crib being at the side of my bed, and being so excited. We all went to bed at the same time, and I couldn't stop touching you. After a few nights I had to move you to the foot of the bed, as it was too distracting having you near me.

I remember on the Friday after you came home on the Tuesday, I took you for your first outing. We went to the toy shop, and to the Cultured Bean. You were in the sling, all nestled and safe, whilst I had a drink and tea cake. Your dad came to pick us up and take us home. I was so proud to have you with me.

The last two years have gone in a blur. I still sometimes can't believe that this strapping, grown up, clever little boy is the same baby, so tiny, so sick. You grasp life with both hands. You are stroppy, you are opinionated and you are, quite frankly, hilarious. You know what you want, and you do whatever it takes to get it. And I love that, I love your spirit, and your humour. I think you are amazing. And never let anyone tell you any different.



Joseph enjoying a special homecoming cupcake!

Wednesday 20 July 2011

Pregnant after a Premature Baby

I still regularly visit premature baby forums and I would like a pound, please, for every time I have read "I am pregnant again and not getting the monitoring or follow up I thought I would". I did a quick ask around on Facebook for my friends opinions and this post is as a result of that.

There are several different scenarios when you have had a premature baby. Firstly the baby may have been delivered to save the life of the mother - which is the case in pre eclampsia as well as other conditions. Ultimately the baby is in trouble too, but the primary reason for the delivery, is to ensure the safety of the mother. The next scenario is the most common, the early delivery for an unspecified reason. Thirdly and less common again, is the early delivery for a specified reason such as infection, or known incompetent cervix.

Many women are told "it's just one of those things" at the time of delivery. And "it may not happen again". I think the most crucial thing is to have a follow up appointment after delivery. In some hospitals its offered automatically. In my case I had a six week check after birth with the consultant. We discussed what had gone wrong in this pregnancy, and we discussed future management of any subsequent pregnancies (right before she suggested we get Joseph a nice puppy instead!)

If this hasn't been offered, I would suggest requesting it. You can either go through your GP (you will have a standard 6-8 week check offered at you surgery) or you can try contacting the hospital directly.

When thinking about trying again, I feel at this point its a good idea to request a pre-conception consultation at your hospital. GPs vary in how much experience they have had with "problem pregnancies" and at this point you may have to stand your ground. A pre conception appointment is a chance to properly discuss what went wrong. Usually in early deliveries, the placenta is sent away for testing, and often these results take a while to come back. So you may have been told initially "it was one of those things" but these tests can reveal more information that can be utilised to assist with management of future pregnancies.

In the case of pre eclampsia it is even more important, in my opinion, to have a pre conception consultation. Pre eclampsia is dangerous to both mother and to baby. There are things that can be done to help keep it at bay, and it doesn't necessarily return in subsequent pregnancies. The earlier you are monitored and put on treatment if required, the better chance you have of having a later, well-managed delivery.

There are trials taking place at the moment assessing the safety and efficacy of progesterone, which is used to help prevent premature birth (it is also used to help prevent miscarriage), the OPTIMUMM trial.

If you have fallen pregnant, don't leave it to chance. It is unlikely anyone will just pick up and read your notes, and the normal protocol for second pregnancies is to have less midwife input not more. So unless you are assertive, and flag up your previous pregnancy problems with your mid wife, you are not magically going to receive better care and preventative treatment.

Having made friends with many mothers of premature babies, and seen lots of subsequent pregnancies, I have seen some examples of exemplary care, and unfortunately, a lot of these examples have been around the London area. But good care should be available everywhere, and often is, but you may need to seek it out.

I think personally, the saddest thing about a subsequent pregnancy, is the loss of innocence, and the loss of a gentle, non invasive pregnancy. If you've had a premature baby, you know what can go wrong, and you live with that anxiety every day, wondering what is around the corner, which I think can be helped by having a good team around you.

I was heartened that in a lot of cases, as the second pregnancy progresses, there is a point where you care considered normal, some time after the gestation in which you had your previous baby, things start to relax, and you can enjoy being pregnant. The access to birthing units, waterbirth etc following a premature baby appears to vary, but some that will depend on the reason your baby came early. If you have had a pregnancy that threatened your life, it is likely you will require regular if not continuous monitoring, and your access to some of the methods offered to "normal" labouring women, may not be open to you. What I would say on this is if someone has said "no" ask them for evidence. No medical person, nurse or doctor, should be offended if you ask for evidence, evidence based practice is the norm, and usually there should be data or studies to back up a decision.

I also think message boards play an important role too. No internet forum should be used as a replacement for medical advice from you own team, however sometimes its good to bounce scenarios and get opinions from other people who have walked your path.

Tuesday 19 July 2011

The Watch and Wait – Prematurity and Long Term Problems

In this post, I am discussing the sort of problems that can jump up and grab you and your family by surprise later, rather than the sort of conditions that are known about at birth or soon after birth and continue to cause complications and difficulties as the child grows and develops.

I recall being asked several times, when will “they” know if Joseph will have long term problems from being born so early and so small. I never really knew how to answer that question. Because, I had worked with adults who were born prematurely and as a result had severe disabilities. Sometimes it is crystal clear when a baby has problems, and if they have lost oxygen at birth, not had the opportunity to benefit from the corticosteroids given to the mother to enhance the babies lungs, not had surfactant at birth, it can be easier to predict whether or not there will be some problems.

When being discharged, I asked one of my favourite consultants that very question. “Is Joseph likely to have long term problems and if so when will we have an idea that there is an issue?” The question was answered by one of the junior doctors, who had recently completed a module on this at university. He explained that as well as physical problems, and general delay, those former premature babies, once at school, can have learning difficulties. He explained that the learning difficulties are often very specific and quite difficult to spot. He gave no reassurance that we would have long term support in this, and we would have to be on the ball as parents.

Later I looked into this further through Bliss, the charity that supports babies born too soon, too small, too sick. It explains it beautifully. One of the huge problems we, as parents, have is that there is little data, and the major study done in this area, Epicure, is, in my opinion, flawed. I would urge anyone concerned about prematurity and ongoing educational problems to read this Bliss leaflet. I think my opinions on Epicure deserve their own post at some point.

Research into the area of learning difficulties and specific problems such as ADHD and autism is ongoing, and but at present, findings are inconclusive. In April 2008 the Daily Mail (yes I know) reported “one in four premature babies faces autism”. This NHS article carefully unpicks the research and discredits the headline. Research has been conducted into conditions like autism, however it is very difficult to “weed out” other causes of autism. And in fact, it is often low birth weight that is implicated rather than prematurity.  No one can say whether prematurity alone can lead to autism. I had read some of the research before Joseph was born, and I was always concerned that this may have to be on our radar. It is one of the reasons I have been very careful about over stimulation, I have concentrated on him having developmentally appropriate toys that are quite simple and natural. I have taught him signing early on, but also encouraged speech through play, songs and reading, without “hot-housing” him.

Another potential risk of being born prematurely, particularly for girls, is the risk of early onset of puberty. As the article explains, early puberty can lead to other problems such as diabetes and polycystic ovarian syndrome. What I find startling, is that there is little information given to parents when weaning their babies and feeding toddlers, who were born at low birth weight. I have heard of so many parents who are desperate to build their babies up, but could be leading them down the path of obesity in later life. Although Joseph was IUGR and very small, I have always been careful with his diet, to ensure it is balanced, with plenty of calories, and but also lots of fruit and vegetables, and I encourage him to be as active as possible (sometimes he takes this to extreme, I have, yet again, had to peel him off the shelves today!) I find it alarming that unless your child has very specific problems, in the UK you are largely left to your own devices. We never had any advice on infant feeding at all, and have never seen a dietician, and my Health Visitor, bless her, didn’t have a clue. 

From what I have read research this post, two things strike me. I looked up prematurity and later problems, and to be honest, there are so many conditions that are potentially linked to premature birth, but a lack of evidence. I know that research is ongoing, and is one of the reasons that I am supporting PiggyBankKids, as they look into this area in more detail.

Secondly, that long term support needs to be put into place for the children who have been born too soon, and their families, in order to detect issues well into childhood and beyond. And I think we are a long way from this at the moment.

Monday 18 July 2011

Pregnancy Police - Do We Need Them

When newly pregnant, you suddenly become aware that your life, suddenly, is not your own. You are hosting another life inside you. It took me a while to get my head around it. The week before I found out we were pregnant, I had been to the amazing Good Food Show at the NEC. I'd had champagne and oysters. I'd had lovely Blackstick Blue cheese. We had a fantastic day and came home with lots of bags of lovely things, including sloe gin.

A few days later, I did a pregnancy test. I immediately felt a sense of responsibility. I knew that the developing foetus was well protected, but from now, I intended to be very careful.

I listened to this blog post being read out at Cybermummy by the lovely Muddling Along Mummy, a plea to be left the eff alone by the pregnancy police.

I am torn about the guidelines in pregnancy and what I believe. I believe that we all should take responsibility for the developing life inside us and take care of it, as we would if the baby was here with us now. Does that mean not having an alcoholic drink in your entire pregnancy? I'm not sure. In the US there are now laws in over 20 states that can cause you to be charged with child endangerment, even murder, if you do something in pregnancy that results in a death or a malformation to a child. Now that, I feel, is going just a bit too far. In some states in the US it is advised that from the moment you commence menstruation until you enter menopause, you act at all times as if you are pregnant, taking folic acid, avoiding smoking and alcohol, and following the food guidelines. That, clearly, is mental.

I do feel the guidelines, such as they are, are not presented clearly enough. I know people who think they have to avoid Philadelphia cream cheese (of course other brands are available) and that is simply not the case. The guideline "soft cheese" is in fact, soft ripened cheese. That is, cheese with a mould, like Camembert or Brie. And there are sound, clinical reasons for avoiding these sort of cheeses (and blue mould as well), and that is listeria. Listeria can cause the placenta to fail, and the baby to die. A good reason to forgo Brie and Camembert I think. There is some debate about whether you can, in fact, eat these hot, because Listeria is killed by cooking, however, I chose to avoid them entirely.

And what about alcohol? The confusion with alcohol is that there is no stipulated and tested safe level. So I think alcohol needs to be treated with a degree of caution and respect. I do think that if you "normally" have a glass of wine of two a couple of times a week, then to continue this, I think, is reasonable. If, however, like me, you are not a seasoned drinker, it seems sensible to avoid it. I am your typical social drinker, I'll drink if out with friends, and with a nice meal occasionally, but I don't drink every day. So in pregnancy I chose not to drink at all, it was no hardship for me, and I was happy with this. Giving up nice cheese was much harder!

Caffeine is another tricky one. Excessive caffeine consumption has been linked with miscarriage. As I had had two miscarriages, I chose to decrease my caffeine consumption to once cup a day, but I didn't cut it out completely. It made me laugh, as I had not come clean at work, and my friend Maddie used to get me coffee every morning. I'd had my one cup a day by then, so when her back was turned, I'd tip it out. Once my pregnancy had become public knowledge, she came to me, quite upset, and said I had had too much coffee in pregnancy and she was concerned. I confessed as to what I had been doing, and we laughed hysterically!

Ironically caffeine is given to pre-term infants, for several weeks whilst in special care. It's used to help lung development. I found it funny that we were giving Joseph pipettes of caffeine when I had been so careful!

So much about pregnancy and the relationship between the placenta and the baby is still an unknown. Scientists know some things, but others are still an unknown. It is clear that too much alcohol consumption in pregnancy is bad, but it is also clear that some alcohol consumption is fine. I think on those things that are not qualified or quantified, its a matter of determining what your own tolerance of risk is, and to make your own decision. Caffeine is another which I think falls into this category.

I think the pregnancy police, those unqualified, well-meaning but misguided individuals that lurk behind cheese counters, sit beside you in cafes or serve you in pubs, are not needed, and should, as Muddling Along Mummy suggests, piss off. However, good, quantified, qualified advice surely should be welcomed.

If you need more advice about what to eat in pregnancy and what to avoid please see the official UK Government website for further advice. The other good source of information on food safetly and pregnancy is Tommy's, which has extensive information as well as a midwife helpline.

Sunday 17 July 2011

Goodbye to NICU

This week, 2 years ago, we were spending the last few days in NICU. Our date of discharge had been arranged for the 21st July. Joseph had a few hoops to jump through. He was still on continuous monitoring, so he had to lose that. He still had a naso gastric tube in. And feeding was still a bit of an issue. But finally, two nights before discharge we were sent to the rooming in room.

This my bed. Our unit didn't have room for couples, so just mum would stay overnight. On the bed you can see newspapers, magazines and a tv remote. I had comfort, time to read, and my baby, who was in a lidless plastic box at the foot of the bed

I could not stop looking at him. I would read an article in the paper, and then gaze at him. He only fed four hourly, so I had plenty of time to gaze and watch. I just thought it was the most amazing time. And really cool, that if I wanted to go out for lunch or pop to the hospital shop, I just wheeled him back into the unit to the baby sitters!

The first night we spent together was funny. I had been warned about the "premmie gremlin" noise. When premature babies sleep, they make a racket. Snorting, creaking, weird noises, that sound porcine, not human. I got used to it straight away. That first night I awoke once, to do his feed, and to give him his medication, and I went straight back to sleep. My husband had arranged to come and see us in the morning, 7.30, before he went to work.

Apparently he'd been knocking for some time. I hadn't heard a thing! He continued knocking and then decided to just walk in. The first I knew of it was this booming whisper (you have to meet my husband to appreciate he can't whisper at all) "Kylie....Kylie...." I bolted upright, eyes wide open "What??? I'm asleep!"

There was a nurse in the the doorway laughing. Apparently its very unusual for the mum to sleep at all when rooming in. For the first time in our journey, I felt complete. And it gave me such confidence that it would all be ok once we got home. The second night was no different. In the morning, I woke up with a beaming smile, got Joseph ready for the day, and wheeled him into the unit so I could have breakfast. I came back and got him and we did all his discharge checks with the doctors. I wheeled him back into the unit again so I could do some paperwork at the general office.

I came back, and we sat, my husband, Joseph and I, and we waited, and waited and waited. Finally, the opthalmologist arrived to do Joseph's final ROP test, the dreaded eye test for Retinopathy of Prematurity. The consultant was so late that the dedicated ROP nurse had had to go home, and the nurse on duty wasn't confident. I offered to hold Joseph. The opthalmologist had met me before and had every confidence in me, so we did the test together. Although horrible, I was so glad it was me, comforting and holding my baby, whilst they held his eyes open. He gave us the all clear.

We could go home. We walked into the unit, tears in our eyes, and said goodbye. A nurse carried Joseph in his car seat to the car, and ensured he was in. I sat in the back seat. And we drove away from that hospital for the last time.

Saturday 16 July 2011

Celebrating our Kids Achievements

I was watching a discussion on internet tv the other day, with mothers discussing all sorts of issues. I forget which one it was, there seem to be so many "mummy" tv channels on line these days. Anyway the conversation turned to "bragging" about our children's achievements.

The panel were saying that they would never crow about something their child has done, for fear of the other parent feeling bad. They feel compelled that if they say something positive "oh Johnny came first in the maths competition" that they have to immediately counter it with "but he is rubbish at spelling".

It really made me think. I am a crower. I am forever going on about something clever Joseph has said or done. I am immensely proud he has over 200 words. But I know 2 year olds who are speaking in full sentences, who are running and jumping. I know 2 year olds who are potty trained. Joseph doesn't do these things yet. But is close on the sentences!

If I "crow" to another mother, I am celebrating Joseph and what he has achieved. And, I expect the other parent to do the same. I would never want to make another parent feel badly about their child, and I think all children are amazing, and incredible, and have something to offer the world. Each child is unique, and a little miracle, whether they are premature or not.

I wonder if its a cultural thing, in Australia we are very open, and very direct. We talk about our kids in glowing terms, we seem quicker to celebrate. In England, people seem a lot more circumspect, and a lot less likely to "brag" about their children.

I think kids should be celebrated! I love talking about Joseph, about words he says, about funny things he does. Obviously, being his mother, I think he's a genius! I love the fact that this little dinky dot, who was so tiny and frail and can stand up on his high chair, girn and say "sit down on botton!" and proceed to defy me! I am so proud of his walking, even though he still looks like a robot left out in the rain too long! I know there are kids faster and more agile than him, but I don't care.

And you know what, I want to hear about your children too. I love to see the pictures on the fridge, the little things they have made, the toys they love. I love the first conversations, finding out what has captured their imagination, what they remember. I love to hear what is important to them. Kids live in the here and now and its exciting.

So please, if I rave about my son, don't take offence. Rave about yours too! Childhood is too short, and too short for competition.

Friday 15 July 2011

This is England

When I was a little girl, my dear Nana always said to me she wanted me to visit England for her, to do the things she had never done and say the things she had never seen. She died when I was 19. My father is English; he was born and raised in Redcar. By virtue of his English birth, I am entitled to a British Passport. It took me a long time to get the courage to do it, but finally I moved.

I decided to move to the North West. At the time, my half brother lived on the Wirral. Although not particularly close I thought having a relative handy if something went wrong. I had no desire to move to London, I was concerned that if I lived there, I might find myself living in an Aussie share house, drinking Aussie beer and listening to Aussie music. I hadn’t come all this way for nothing, I wanted to assimilate. Also, I had met a bloke on the internet who lived in Manchester, and we decided we wanted to pursue a relationship, which went a long happily for several years.

I guess the things I like about England are really tied up with what I love about Manchester and the two will diverge.

Natural beauty – I find England stunningly beautiful, and diverse. Where we live, to the North of Manchester not far from the Lancashire border, is just gorgeous. We live on the East Lancashire railway line and it makes my heart sing, to do the 30 minute round trip from Bury to Rawtenstall. I find so much of England just lovely, and really easily accessible.

Accessibility – I don’t drive. In Tasmania this was always a massive issue. Buses were infrequent, didn’t always go places that you would want to go, and to get between cities was dreadfully costly. The place was built for cars. In England I find it so easy, I can get from Manchester to London under three hours. I can get to Wales and to Scotland. Europe is also very easy. I don’t feel trapped like I did in Tasmania.

Opportunity – I have had amazing opportunities I never would have had at home in Tasmania. I have been able to change careers, to go places, to do things that at home were just completely not available.  I’m not one hundred per cent sure what would have happened if I’d have had Joseph in Launceston, we probably would have had to be airlifted to at least Hobart. I had a stunning wedding here, I’ve been in the paper a few times, and I feel my life here is full of opportunity and promise that had deserted me in Tasmania.

Humour – I have to admit, I don’t always get it. Sometimes I think being people are being serious and they are totally taking the mick! (Equally my directness sometimes is taken for sarcasm). I love the humour of everyday people, especially the old, crusty Lancastrian chaps. I like the banter at the bus stop, and going into a pub and having a good yarn. There is a warmth about England that I just love.

Shopping – Although not a massive shopper, I love shopping in England. Clothes in the supermarket, interesting specialty shops, shops full of fat clothes! In Tasmania my choice of clothes was very limited, although now its improved, the clothes are so much more expensive than here. And they are made in China and have dubious providence with a high price tag. I love a bargain and I love being able to buy things that fit me. I do get a little disheartened about the high street here, and that a lot of towns have started to look the same, and I do try to support independent retailers when I can.

Architecture – Australia, of course, is an ancient country, but in some senses very new. I still get a buzz from seeing buildings that are 500 years or older. I love how in Manchester in particular, there’s a fascinating juxtaposition of the old and new, side by side. I love how they haven’t tried to be too sympathetic when constructing new buildings, and there is such modernity and foresight as well as beautifully old buildings.

Christmas – It seems particularly odd talking about Christmas in July but I so love the festive period in England. All the carols from my childhood make sense, the familiar imagery; the smells all seem more poignant and relevant here. I adore the Christmas markets, the lights and the food. After my first Christmas here, my homesickness all but disappeared. 

Art – I am the most casual of art appreciators, however, I love a good gallery, and there are so many, particularly in the North West, that I go to and love. For me, art must be accessible, it must be free or cheap to look at, and it needs to have an element of fun too. I find that England gets this 100% right. I love the refurbished Manchester Art Gallery, the Whitworth, and the Walker in Liverpool. And in London it’s even more inspiring. 

People – I find English people funny and warm. It takes a while to “break in” and make friends here. Often Australians are a lot more casual about friendship, and hence it’s easier to make friends there, but true close friendships are valued highly by the English, and once you have made a friendship, you have it for life.
I am passionate about this country and I adore it. Yes, it has its problems, and there are a lot of them. But there is a resilience about England that I love. That saying “Keep Calm and Carry On” that has precious little to do with war time England, does seem to sum up the place. 

I’m not sure if I’m here forever, or if at some time in the future I will move back to Australia, or even to someplace else. But for now, England is my home and I am very happy here.

Thursday 14 July 2011

Express Yourself - Pumping for Your Premature Baby

Breast milk is the ideal first food for premature babies. It’s gentle on the stomach, its custom made, and it’s a special thing only you can do for your baby. No nurse or doctor can do this, only you, your baby’s mummy.
If you have never considered breast feeding, it’s really worthwhile giving it a try. You don’t have to go on to breastfeed your baby (and occasionally it doesn’t work out, and I think it’s a good idea to mentally prepare for this, I didn’t). Even if you only express the colostrum, the liquid gold that appears before your milk comes in, this is very valuable, and will help provide some protection against infection for your baby. 

When Joseph was tiny, and strung up to all manner of monitors and had iv lines in most of his limbs, it was so lovely to see him being given pipettes of my milk to give him comfort. It made me more determined than ever to express for him. Joseph had to be on Total Parental Nutrition (TPN) for the first couple of weeks of his life in order to build up his weight, and to protect his tummy from infection. This gave me a head start. Here are my tips.

Where do I start? It is recommended by most lactation consultants that you hand express only for the first few days, you should do this as soon as you are able. Your midwives on the delivery suite will be happy to show you how. There are also some very good clips on You Tube to show you how. You may find it beneficial to look at photos of your baby. This did not help me, Joseph's first photos were distressing, but I did find having a little hat he'd worn or a muslin he'd been wrapped in helped enormously.

When can I use a pump? You can use a pump once your milk comes in, which is normally day 3 but can be a bit longer. Don’t be alarmed (particularly if you have a later gestation premature baby) if they are put on formula for a couple of days. Unlike term babies, premature babies have no or little fat stores to keep them going until your milk comes in. It’s not a reflection on you, and you have not failed, it just takes time for your milk to come in.
What pump should I use? If you are expressing for any period of time, you need an electric pump, manual pumps might be ok for short periods of time, but for full time expressing you need an electric one. I personally used Medela, but there are many other brands now available. I do think, if you are pumping for any length of time, you need to double pump. I have been “test driving” a DVD for families of premature babies and have to share this tip with you. You can buy very expensive pumping systems so you can pump hands free. Or you can get a sports crop top, cut two “Madonna holes” in it, and stick your pumping cups through the holes, and away you go!
How often should I pump? This is the million dollar question and everyone will tell you something different. There are two standard responses to this question. The one given by our unit and most neo natal units, is to pump every 3 hours, and once your milk is established you can go up to six – eight hours at night. The other school of thought is that you should be expressing to a similar schedule that you would be feeding your newborn, that is 10-12 times a day.
I am going to be honest. I think the every 3 hours advice is the one that most people will be able to do and not go barking mad. Even the every 3 hours is hard, especially if you have other children. Expressing full stop is very difficult when stressed, and stress will not help your supply. So my advice is, if you can express 10 – 12 times in a day then that is wonderful and is going to give you a great start and a lovely supply for the future. If you can only manage every 3 hours, then there is plenty of evidence that that maybe sufficient. If you can’t manage that often, you will still have some milk for your baby and that’s wonderful.
How do I store my milk and how long for? Please be guided by your unit’s protocols, however this is the advice I was given. Milk can be stored in pots (provided by the unit) or in plastic bags. I had bags that hooked directly on the pumps. The bags take up a lot less room in the freezer. Make sure all your pots or bags are clearly labelled (some units provide ready printed sticky labels) and clearly dated. The unit will use the oldest milk first. Fresh milk is best, so I used to try and express into two containers and make sure they used some fresh and froze the rest.
Milk can be refrigerated for 24 hours for a special care baby (for a term baby its considered fine for 48 hours) and can be frozen for up to 3 months for a special care baby (up to 6 months for a term baby). When defrosting make sure it is well shaken, as it will separate on defrosting.
A word on massage – it is vital you gently massage your breasts before each expressing session. I did not do this religiously and still have pain now on occasion, and have not breast fed or expressed for almost two years now. The massage only needs to be gentle, and can be done in the bath or shower, or your partner can help. This helps get the ducts working.
My supply is dwindling and I don’t know what to do – the quick fix is domperidone also known as Motilium. This is a medication used for stomach upsets, to improve stomach motility (the transit of liquids and food), ironically many premature babies are on this medication for reflux. Domperidone improves the let down reflex. It is not licensed for this purpose, and some GPs may not prescribe it, however most units will have a “domperidone letter” you can give to your GP.
Herbal supplements can help, and the two most used ones are Fenugreek and Milk Thistle. You can buy these from most health food shops. You will need to tell the unit if you are using Fenugreek, as it does change the consistency and smell of your babies poo.

Ask the unit to show you Kangaroo care, if you are not doing this already. Skin to skin contact with your baby may help your supply and in particular the "let down" reflex to release more milk. Expressing by the cot side may help too. 
The longer fix are the following – drink plenty of water. I was advised to drink no fizzy drinks, as it is dehydrating. I would also go easy on tea and coffee. Fruit juices and smoothies are fine, and now is not the time to worry about calories. You need calories in order to have the energy to express. I was also advised to eat – a lot, and to supplement with chocolate in order to get enough calories. Oats are a really good food, and if you have a slow cooker you can cook porridge in there and keep it for a few days if you make it with water, and just add milk to it before you eat it.
Stress can impede supply. Worrying about getting stressed will make it worse. The best way to cope with a baby in special care is to use all the sources of support you can, to find what works for you, and to take time out. Go for a walk, go out for a meal with your partner, have a haircut or a massage or a pedicure, your baby is well looked after.
Ultimately, if you are trying to express, that is wonderful, and if you find that it is too hard, and you are getting too stressed, then be prepared to make some difficult decisions. I know the day I put my pump away was one of the saddest days of my life, but also one of the most freeing.  In my case I was finding that my milk had to be fortified to give Joseph what he needed, and then he had to have formula as well as my supply stopped meeting his needs.
Any breast milk you can provide will be beneficial to your baby.

Wednesday 13 July 2011

What’s Stopping You From Using Cloth Nappies?

There are so many myths and misconceptions about cloth nappies. Now I know they are not for everyone. I am not so sure if I’d had multiples (twins or more) I would have bothered. But I love them, they are easy to use, easy to wash, and they are pretty.
I do enough washing as it is – with cloth nappies, you can get away with doing a wash every 2-3 days. It’s easy, you can use a paper or mink liner (I find now Joseph does *ahem* people poo, it just bounces off the nappy anyway. You flush the solids then pop the nappy in a pail (preferably lined with a mesh liner) Once the liner is full you pick it up (the liner that is) and throw it in the wash. I normally do a rinse cycle, then wash with a dessertspoonful of non-biological powder on a 60 degree wash. I then normally rinse again.
But live in a flat/don’t have a tumble drier – I lived in a flat for Joseph’s first year, and I have never owned a tumble drier. Most nappies don’t like being tumble dried. In summer I put my nappies outside. The sun is good for nappies, even cloud filtered sun, and bleaches any stains. In winter I dry inside. If you are drying inside more often than not, then its best to choose a fabric that is quick drying.
There are so many types, styles and fabrics, how can I ever choose? I won’t lie, at first, its completely and utterly bamboozling. There are so many types and so much terminology that it is bewildering.  Here’s a brief rundown of some of the terminology.
AIO – All in Ones, nappies that are completely self contained, no separate parts required. These can be one sized, which have rows of poppers so you can change the size to suit your baby, or sized, usually in small, medium and large. These are usually slim fitting.
AI2 – or 2 part nappies – these are similar, they have a water proof layer and then boosters or pads for absorbency. AI2 are more customisable than AIO’s and sometimes quicker drying.
Pocket nappies – these have a waterproof layer, and a stay dry layer, and a pocket where you can stuff them, usually in advance. These are totally customisable.
BTP – birth to potty, used to describe a nappy or a system. Personally I think asking a nappy to be a BTP is a big ask. A newborn’s needs are completely different to a toddler. I do think it’s best to buy enough to get you through a few months, and then add to it over time. I did buy a BTP system, and I did use it a lot, but have found I’ve had to add to it.
Why are there so many fabrics? What’s the difference? There are two functions of the fabrics used in nappies. The first function is to be waterproof. AIOs, AI2s and Pockets have a waterproof layer, usually PUL (polyurethane laminate). This is a waterproof fabric which is light. It doesn’t like to get too hot, so no boil washes or tumble drying (except on a very low heat) Sometimes the PUL is covered in a pretty fabric, often minky, which is soft, and often very pretty!
You can also use, surprisingly, fleece or wool to be the waterproof layer. Unlike PUL which traps the liquid, these two fabrics wick the moisture away. They are great to use at night time with microfleece or with terries or with bamboo nappies.
Inside the nappy there are lots of different options and I won’t go into all of them. For newborns, muslins work well, just contained with a waterproof wrap.  I love bamboo. I am happy to put up with the fact that it is slow drying, as its absorbency is second to none. The downside with bamboo is that you have to wash it a few times to improve its function. This is where buying second hand is wonderful. You can use cotton terry nappies, these also provide good absorbency. Microfleece can be used as “stuffers” for pockets, or to provide additional absorbency, or you can buy microfleece nappies that fix with Velcro or poppers.

Microfleece is super fast drying. My first system was microfleece and no word of a lie, inside with no heating on they only take three hours. The only downside is that the need a separate wrap made of PUL over the top (or fleece or wool pants). They can be bulky underneath clothes, particularly on boys.
My favourite nappies
I buy my nappies on line. The shop I buy most from is Cheeks and Cherries.
My favourite nappy are Bambooty Easy Dry. These nappies are bamboo but are constructed in such a way that they dry very quickly. They are super slim as well, and fit as well as a disposable, in my opinion.
My next favourite are Itti Bitti. These nappies are bamboo as well, but more padded than the Bambooty. I love them, as their colours are bright, and the outer is minky, soft and bright. I like these best with a funky t-shirt, leggings and a smile!
I have a couple of the Tot Bots Easyfits V2. I love these nappies, as they are made in the UK, and are stocked widely, even in our local Tescos. They are slightly fiddly, half way between a pocket and an all in one, the insert is attached but has to be folded inside. I love the fit of these nappies, and they have cute designs.
So, I want to try what do I need to get started?
A bucket
A mesh liner
5 nappies (more if your committed already!)
A child
Some non bio washing powder or liquid
You may want to go the whole nine yards and use “washable wipes” which to me are just flannels and water. I tend to use this at home, but normal baby wipes when out and about.
I strongly advise that you start out slowly, and find the nappies that work for you and your family. I think the danger is that you can get too excited, spend too much money and then become disillusioned. I know so many people with huge stashes of nappies that have been used for a week or two, then put in a loft out of the way.
Personally, I find cloth nappies have saved us money, are fun, and I enjoy using them, but if I didn’t love them,  I wouldn’t use them. Nothing is worth doing if it’s going to drive you mad, but give it a try!

Tuesday 12 July 2011

On Being an Expat - or Why I Left Tasmania

This was meant to be a piece on what it's like to be an expat, but as I wrote turned into something entirely different, and a welcome, I think, excursion away from prematurity. 

Please, don’t ever ask me “what are you doing here?” with an incredulous look on your face. I don’t know, alright? It just seemed like a good idea at the time. I was on the cusp of turning 30; I always said I’d do something outrageous for my 30th. I did think it would be backpacking with my husband and 2 children in the Kimberleys (Western Australia) however, 29 saw me single, childless, and absolutely fed up in the fish bowl that was Tasmania.

Now Tasmania is not, contrary to popular belief, a small island with one school and one road running through it.  It’s a fairly sizeable island with a population near half a million. Now don’t get me wrong, it’s stunningly beautiful. It has wilderness beyond imagination, temperate rain forests, a wild river, beautiful bush, amazing mountains and glorious beaches. The air, for the most part is pure. The raw produce, vegetables, fruit, fish and meat are second to none. There are vineyards and wineries, seemingly around every corner. The cheese that’s produced in Tasmania and its outlying islands is some of the best in the world.

There is wildlife too, the fascinating Tasmanian devil, pademelons (like a small wallaby), quolls (the native cat – as destructive as an English fox) and endless species of birds. There are unique orchids, stunning trees, such as the native Huon pine, and other very beautiful old growth trees. Tasmania is a stunning place, and I am privileged to have been born and raised in this very special place.

Tasmania also has a lot of artists, and musicians. It has a world class orchestra. Tasmania invests a lot of time and money in festivals. It has a newly opened Museum of Old and New Art (MONA) which is, I think, pretty much unique for anywhere in the world.  There are lots of opportunities for craftspeople to show their wares, and vibrant markets, like Salamanca, a meeting place for artists, musicians, foodies and everyday people to mix and to gather in an atmosphere that I have never experienced anywhere else. 

So if Tasmania is so wonderful, what, in fact, am I doing here? Tasmania is tiny. It is very hard to find work, unless you are especially gifted, clever and persistent,  it is difficult to find an entry level job. There is a lot of competition in the job market for the most basic of jobs. When finishing university I found it impossible to find work, and did a course retraining me to care for adults with disabilities. 

Tasmania has a very dark side. The suicide rate, particularly for young men, is amongst the highest in the world. The murder rate is also very high. Tasmania is very insular, and its difficult, if you make a mistake in your life, to cut your losses and move on. 

If you recall the Hollywood concept of six degrees of separation, in Tasmania this translates to about 3.2 degrees. I recently went back for six weeks, and without trying managed to run into my ex-husband’s stepmother and father, without trying in a restaurant in Hobart. Hobart is quite a large city with many eating places, but this sort of thing happens all the time. I recall once working in Fiji on a community project and I met a girl about my age, 19, and she said “oh Tasmania, I know only one Tasmanian, Mr Dutta”. Yep, sure enough, he was one of my teachers at college. Every Tasmanian can tell this sort of story. In fact, in my first week in Manchester I was with a friend eating in a pub and I whispered “I am sure I know the waitress”. She came up again and we got chatting. Yes, she was one of my ex-boyfriend’s ex work colleagues, from Launceston, Tasmania, the town where I worked and studied for over 10 years of my life.

One of the problems with Tasmania is that it is incredibly isolated. The little stretch of water, known as Bass Strait that separates Tasmania from the Mainland (or North Island as some Tasmanians call it) is quite small, it costs a considerable amount to cross it either by plane or by boat. And the crossing point by boat is about a 3 hour drive from Hobart, the capital city. Due to this isolation, there are some things that happen rarely in Tasmania, such as visits by well known bands. We don’t see classic works of art very often, I’d never seen major European works until I moved here.

Tasmania compensates for this by producing its own artists and musicians, but it isn’t always a fair exchange. I remember as a teenager even the then Premier, Robin Gray, on the 6 o’clock news making an appeal to Boy George to bring Culture Club to Tasmania. I may have hated his politics, but his bumbling rendition of Karma Chameleon was endearing. He even gave him the key to the city of Hobart. Dunno that Boy George ever used it. Perhaps I should ask him on Twitter. Dare me? 

I remember writing letters to Duran Duran, Wham and later once I’d matured a bit to U2, and to endless other acts, pleading with them to come to Tasmania. To get to the mainland to see a band as a teenager was impossible, unless one had young and hip parents with plenty of money, which I didn’t. Big musicals didn’t come to Tasmania, we had our own theatre companies that would sometimes reproduce them, but it just wasn’t the same. The only thing that “helped” was the Port Arthur massacre in 1995 (?) – I think it was this year, but I refuse to Google it on principle. This made a few bands come to Tasmania in the subsequent twelve months. The Cranberries at the height of their fame and the Presidents of the United States of America are two that come to mind. But soon it was forgotten, and no one bothered about Tasmania much.

All the issues Australia has of being separated from Europe and the USA are, for Tasmania, even more keenly felt, and that makes it difficult to have a very well-rounded world view. I was very blessed to be able to travel overseas at the age of 19 to Fiji. For the first time I saw poverty. I saw very obvious distinctions between the rich and poor. And it opened my eyes to what life could be like, living in paradise, but living in abject poverty. 

However, international travel was out of my grasp, I could never earn the sort of money it would take in order to be able to travel. So once I had saved enough, I left, with the premise of working for a few years, saving some more money, and coming back for good.

And I know people think that it was because I fell in love and had a baby that I settled here, but truth be told, my decision was made before I met Man of the House, and long before Joseph arrived. The truth is, I love England. The reasons I love it are a post for another day. But here, in short, I feel a freedom that I never had in Tasmania.
That freedom isn’t the reason I left, as I never knew I didn’t have it, but it is, the reason I stayed.