Pregnancy and Birth Across The Pond: From Trinidad to London

The long walk to the Women’s Health Department in the Sutton hospital was almost déjà vu. The physical building resembled that of Port-of-Spain’s General Hospital. I suspected both institutions had been designed in the same era.

In many ways, public health care in Trinidad and Tobago resembles the UK’s National Health Service (NHS). Both systems are state funded, claim to be under financial pressure and are heavily criticized by the public they serve. The NHS today is frequently in the spotlight with problems that are old thorns for Trinidad’s General Hospitals: unacceptably long waiting times at the Accident and Emergency; overcrowded wards; patients unable to access non-emergency care at their local centres; shortages of doctors; questions over expenditure by administration; client deaths linked to inadequate care.

It’s well known that the human resource element in Trinidad and Tobago’s public health system has not in recent decades been able to support its clients by spoiling them for choice.

I chose private care for my first and second pregnancies in Trinidad because this allowed me the luxury of choice; which doctor or midwife to see; when to schedule appointments; which hospital to choose; what to include in my birth plan; if to have a doula; even some choice over my post-birth breakfast menu!

I wanted to avoid the unpredictability of being attended to by various strangers. Relationship building takes time but builds trust. Trust facilitates confidence and confidence makes birthing easier, on the mind, if not on the body.

For my third pregnancy I found myself living in the UK. I chose to be a client of the overburdened NHS for my third pregnancy, would I be satisfied with my options?

Well, the policy of the NHS is to encourage home births where possible since studies of UK and similar populations show that home births cost less but add no significant increased risk for “low risk pregnancies.”

Waiting to see the midwife for the first visit 12 weeks into my pregnancy, I found myself in torrents of tears after looking at the cards and photographs posted on the walls from families that had chosen home births. An emotional bomb had hit me unexpectedly. Underneath the nausea and fatigue there was a little human being under development who would, by God’s Grace, be joining us just six months into the future. Reality hit home.

The midwife loaded my answers to her numerous questions into her computer programme. The programme did its analyses, reducing the error of human misjudgements. I was deemed “low risk” and a candidate for home birthing. This, despite me being almost two years short of the big Four Zero!

I was thrilled.

The midwife who was responsible for managing home births in the area was an amazing woman. Like my obstetrician in Trinidad, she gave me all the time in the world when my questions needed to be asked and my anxieties needed to be addressed.

She emphasized my right to choose a home birth. She showed me the assessment criteria for home birth to be met towards the end of the pregnancy but expressed her conviction that the client’s right to choose should prevail. She referred to women who did not meet the criteria but whose preference for home births was respected despite contradicting medical advice; one woman was diabetic; another was giving birth for the seventh time. “We cannot refuse to come, once we have the staff,” she insisted.

Pregnancy care under the NHS offers more routine screening blood tests (including assessment of body iron stores and degree of Down Syndrome risk) and shorter waiting times than typical community health centres in Trinidad and Tobago. On the other hand, under the NHS low risk women have half the number of routine clinic visits on their schedule and perhaps because I never appeared over or under weight I was only ever weighed once.

To my surprise and horror I was expected to bring urine in a narrow glass tube supplied by the clinic, wash the tube and use it again for the duration of the pregnancy! Yes, the NHS has been under great pressure to manage its expenditure but I have to admit their system is more environmentally friendly than the use of styrotex cups!

Midway through my nine months I learned of a card for pregnant women which entitled me to free medicine and dental care for the pregnancy and first year after baby’s birth. Well off I went to the dentist, grateful for my savings of a few hundred pounds and mindful of the money previously spent because I did not know about this ‘pregnancy privilege!’  There were no doctors at the community clinics I attended so though the midwife could recommend iron, she couldn’t write a prescription and I had to wait my turn at the GP’s office again – or pay at the pharmacy.

I took the tour of the hospital’s labour ward and birthing centre. It was delightful to have the option of a water birth in a private room at a birthing centre but in the end the attractions of a homebirth won me over. In theory I could have rented my own birthing pool and had a water birth at home but the labour proceeded so efficiently when it did get going that I doubt I would have even made it into any pool.

A must read if you are interested in birthing naturally and in understanding waterbirth!

Gentle Birth Choices by Barbara Harper, a must read if you are interested in birthing naturally and in understanding waterbirth! I really wanted a waterbirth after reading this and after being introduced to the subject at the Mamatoto birthing centre in Belmont, Trinidad. But in the toss up between the inconvenience of renting or buying – and filling (then emptying and maybe selling) a pool at home, versus using the waterbirthing facilities at the hospital’s birthing centre in Sutton, home birth pool free actually won! Any my early labour was so long while my active labour was so short, there would have been no time to get in and out of the pool anyway!

After the birth, our doula (labour support person), made the midwives tea and brought them fruit and chocolate we’d set aside for them as refreshments. We took photos together. NHS policy emphasises the role of the midwife in helping mother and baby to get started with breastfeeding and the midwives were happy to wait for baby to have her first feed before weighing her.

She was remarkably calm. She nursed and slept and was unperturbed by the activity and conversation around her. And if it  wasn't for our doula we would have had no photos of her first hour as her grandma and dad are not camera enthusiasts!

She was remarkably calm. She nursed and slept and was unperturbed by the activity and conversation around her. And if it wasn’t for our doula we would have had no photos of her first hour as her grandma and dad are not camera enthusiasts!

Midwives and the district health visitor made at least four visits to our home in the two weeks that followed. It was wonderful not to be roasting our newborn at the bus stop in what was a sweltering hot summer. It was comforting to know that the system actively searches out mothers at risk of postnatal depression. The home visits also seek to help and support breastfeeding and even though this was my third time with a nursling, they had some useful reminders and assurances for experienced mums too.

Despite the conscious efforts by midwives both in the UK and T&T to encourage, inspire and support breastfeeding, not many women breastfeed exclusively for the first six months. In the UK new mothers are less likely to have the family support needed to facilitate sustaining breastfeeding and despite knowing that best is breast, despite baby latching on and breasts full of milk,  the sheer quanta of time required to breastfeed means that many busy mums – even stay-at-home mums – are defeated before they begin.

Reading about breastfeeding is a useful part of preparing for your new baby. You won't have time to do much of it once the little one arrives.

Reading about breastfeeding is a useful part of preparing for your new baby. You won’t have time to do much of it once the little one arrives.

The Birth Book by Sears and Sears

Read as much as you like but be sure to attend birth preparation classes too! Nothing replaces the insights of experienced women. Nothing replaces the sharing and caring, the camaraderie amongst pregnant women. The Birth Book by US paediatrician Dr. William Sears and his wife, registered nurse and midwife, Martha Sears.

Nursing Mother, Working Mother by Gale Pryor

You may have thoughts of pumping and working but don’t rely on optimism or even on Gale Pryor’s brilliant book, Nursing Mother, Working Mother. By all means, learn what you can from books such as this one but your strategy and how best to execute it must come from women who’ve done it successfully, from understanding the obstacles you might face and maybe even from working with the breastfeeding counsellors and consultants whose experience and guidance can sometimes be a make or break factor.

While breastfeeding and ‘low tech birthing’ for low risk mothers with adequate antenatal care are cost effective for the national purse, in Western society freedom of choice is upheld as a sacred principle. Yet with dire predictions that nations’ health bills will be strained by ageing populations heavy laden with Alzheimers’, cancers and other chronic diseases, will a push towards natural birthing and breastfeeding be forced into policy? And isn’t policy impotent all by itself? In the UK, home births and exclusive breastfeeding remain the exception and not the norm, despite the policy support they enjoy.

For women to embrace breastfeeding and low tech birthing as gold standards to be aspired to where possible, the following would be imperative:-

  1. Conveying the information and reassurance needed for women to embrace such options with conviction.
  2. Providing adequate and flexible maternity and paternity leave
  3. Providing easily accessible and relevant antenatal classes for all
  4. Providing workplace support for mothers who wish to pump milk at work
  5. Providing competent and widely accessible breastfeeding support for mothers after birth.
  6. New training and retraining for a wider cadre of supporting health care workers.

This article was first published by Fresh Start, the on-line magazine of Best Start, the breastfeeding and advocacy organisation run by the very dedicated and amazing Adepeju Oyesanya. Thankyou for the privilege of publishing with Fresh Start, Adepeju.

The article was first published on page 20 of Fresh Start’s May 2014 edition, link below: 

http://issuu.com/freshstartbybeststart/docs/fresh_startbybeststart_may_2014__4

The original publication did not include the photographs that are part of this post.

Moments of Pregnancy; Love, Tears and Magic.

When a woman confirms her pregnancy, how does she feel? Elated, excited, depressed, disappointed, surprised? Or none of the above. She might just feel numb. And here friends, is where we begin.

You and your baby are unique and your first forty or so weeks together are too. Your thoughts, feelings and experiences may be nothing like what friends and relatives expect for you. As I write this I’m carrying pregnancy #3 and it certainly has not been just the same as for #1 or #2! So you don’t have to feel excited, thrilled and expectant in the first weeks or months. It’s fine if nausea and uncertainty overshadow everything in the early days. If you are miserable, find that trusted friend to talk to.

It’s possible to have an enviable “perfect pregnancy”, marked only by a change in body shape (sexier than ever as the months go by), an increase in appetite and maternity leave forms – but for many women having a “normal pregnancy” there are all sorts of changes. Fatigue might hit you for six. “How could a creature the size of a kidney bean be making me so tired?” you ask. Give it a rest, mum. Baby Making is hard, detailed and technical work. So sleep when you need to. The world will continue without you. If necessary, accept help without guilt should it come your way. There’s plenty of time to return the love with kindness of your own when you are feeling better.

Interest in sex sometimes (thankfully not always), drops to an all time low in the early months. Do reassure your partner that this won’t last forever. Acknowledge and respect his feelings even if you can’t accommodate them. Remember he might be silently panicking, imagining being pushed aside, replaced by his baby. Tell him the truth: lots of women feel a resurgence of their sexiness and desire by the middle of the pregnancy. Could he just be patient and loving till then? And by then with your growing tummy, you might have to find new twists on old positions in order to make sex work for both of you!

Many mums-to-be find that nausea and vomiting resolve by mid-pregnancy if not after the first three months. However mid-pregnancy may bring with it aches and pains as the weight of your child takes a toll on stretching ligaments and back muscles. Gentle stretching exercises taught at antenatal classes, but also available on-line and in popular books like “What to Expect When You Are Expecting” go a long way towards strengthening muscles and reducing discomforts.

Sadly I was often too tired to find the time for more than a few of these exercises myself but go for it if you can!

Sadly I was often too tired to find the time for more than a few of these exercises myself but go for it if you can!

Still, with a bit of lower back pain each time, I did make time for The Cat and it always made a positive difference!

Still, with a bit of lower back pain each time, I did make time for The Cat and it always made a positive difference! Source: Yoga for Pregnancy

Baby’s movements by mid-pregnancy increase your bonding with your little one. For some women warm feelings and positive anticipation don’t begin till the movements do. Later, baby’s movements can be felt – and sometimes even seen by baby’s daddy and siblings, making the baby more real in their minds and helping them too to begin bonding.

As pregnancy progresses women often worry if all the fat gained will ever be lost. After all, so many mothers blame their pregnancies, often their very first or only pregnancy, for fat that hangs on for several decades to come!

Here are two strategies to help you make sure your pregnancy fat is useful fat that will be lost in good time:

  #1 Eat healthy during pregnancy and afterwards. Minimize or cut out fried foods, sugar, sugary drinks and sweeteners and ensure daily intake from all food groups. Be guided by appetite, avoid delaying meals and stop when full. Weight gain should then be only what your baby needs from you during pregnancy.

And for strategy #2 breastfeeding! You may well slip back easily to your pre-pregnancy weight after just 6 months of exclusive breastfeeding! It’s true that birthing and breastfeeding are all natural.

As birth approaches, genuine fear and anxiety about birthing are not uncommon. Many women don’t feel an unwavering confidence in the ability to breastfeed. I admit to nagging doubts in my first pregnancy. After all, I have a low tolerance for pain. I would never even prick myself with a pin for a dare. How then could I endure labour? I remember hearing my first labour story at age 11. It lasted 18 hours!

As for breastfeeding, suppose I couldn’t remember the pictures in the book showing me what a correct latch-on looks like for a nursing baby? Suppose it was all too much for me? And when you hear the doubts rehearsing themselves in your head, that’s your signal to get the support you need.

For me the solution was in finding friends and midwives who built my confidence with their own experiences and knowledge. When a friend affirms, “I nursed both my daughters for two years, no regrets,” then you think, “Oh, if you did, maybe I can too.” “These women chose a completely natural childbirth,” says the midwife with a quiet confidence. And then you find yourself in a deluge of your own tears as you see them birthing, supported by midwives – and then holding their newborns, on the videos and slide shows. You start to believe that maybe you are the agent to birth your baby. You stop seeing yourself as a would-be victim of a painful, unpredictable event. “In these sessions we’re going to learn how you and your birth partner can cope with the discomforts of labour. And these exercises will help your body be better prepared.” Wow! Tears fill your eyes again. This was just what you were looking for!

In addition to birth preparation classes, lactation classes are also available. Lactation classes allow you to explore breastfeeding and build your confidence with professionals who can also assist you during the first 6-8 weeks of nursing baby – when new mums have the most doubts and are most likely to give up.

The first few weeks after birth are usually challenging in one way or another. Resolving as many areas of uncertainty as possible in advance of your precious arrival is a sensible investment.

Breastfeeding By Sheila Kitzinger was the first breastfeeding book I ever read. It's worth ordering on-line. I was blessed to find it in a local bookstore 12 years ago. I couldn't read it without inexplicable tears though. Almost every picture of a nursing baby and mother caused the tears to well!

Breastfeeding By Sheila Kitzinger was the first breastfeeding book I ever read. It’s worth ordering on-line. I was blessed to find it in a local bookstore 12 years ago. I couldn’t read it without inexplicable tears though. Almost every picture of a nursing baby and mother caused the tears to well!

Your Baby and Child by Penelope Leach, tear jerkers

Penelope Leach’s amazing book Your Baby and Child, Birth to Five Years is a must read as birth approaches. It also makes a great baby shower gift. For me, the beautiful pictures provided another source of choking up on tears!

Yet there’s an emotional fortress that you build from real live human support that you can’t get on-line or even from books. Seek it out.

Perhaps in pregnancy we acquire an increased emotional sensitivity for the purpose of connecting both with other mothers and our own babies. So powerful is this sensitivity that you may find yourself feeling connected to mothers and their children everywhere. You shed tears over a mother losing her child to war half the way around the world or for a six year old you never knew personally recently diagnosed with leukaemia.

Later, in the hustle and bustle of parenting your new born, your awareness of this connectedness may fade, but in truth it is one of the most precious lessons that pregnancy teaches us. We are one species and we are connected by sadness and pain, by joy and love, by our common humanity.

This article was first written and published for Fresh Start, the e-magazine of Omo and Best Start. It appears on page 7 of Fresh Start’s August 2013 issue under the title Mummy Matters. Please see the link below in which there are several other articles of interest!

http://issuu.com/freshstartbybeststart/docs/fresh_start

I do thank Mrs. Adepeju Oyesanya for blessing me with the opportunity to share these thoughts and nuggets with my pregnant sisters everywhere. Feel free to share away. Motherhood in all its breath and depth, connects the human spirit like few other things do. We are one in our common humanity and foolish to so easily and often forget our oneness.

The above article has been expanded and edited slightly and all photos are of books from my personal library and were not part of the original publication.

On GM Soy. Ubiquitous so Surely Safe?

Soy is a food we give little thought to. Yes, soy sauce is a must for our pot of fried rice and we’ll dash some on the Chinese take-away but in the Caribbean soy itself is hardly a traditional food. Pigeon peas and lentils can be found bubbling in our pots but how many of us cook soybeans?

Still, lots of our babies drink soy milk formula and many women consider switching to, or adding soy milk to their diet as they approach age 50, in the hope of reducing breast cancer risk.*

Soy is the main ingredient in meat alternatives on the market for vegetarians locally. But burger and sausage meat packaged as chicken, beef or pork as well as many snack foods also contain soy by-products.

Soybean oil is no longer considered a healthy option but it continues to be widely used due to cost considerations. You may have noticed it mixed in with less expensive versions of ‘olive oil’ – if you take time to read labels at the grocery!

While the food industry continues to make wide use of soy, production and supply of genetically modified (GM) soybeans has expanded. First introduced in the 1990’s, more than 80% of soy produced in the USA now is GM-soy. Argentina now uses more than 50% of farm land for GM soybean cultivation.

Much of this GM soy is then fed to livestock all over the world.

UHealth Digest April-June 2013

UHealth Digest April-June 2013

Though you may be barely aware of it, GM soy has been in the food chain for more than 15 years.

Different types of GM soy are developed to bring different benefits for the industry. The type grown in the USA and Argentina withstands a powerful herbicide known as Roundup. How? The Roundup Ready Soy crop can detoxify the herbicide when it enters the plant cells, so the weeds are exterminated and the crop survives.

Could This Process Pose Risks?

The bio-technology industry predicted less weedicide would be needed with the introduction of Round Up Ready Soy. In the first few years this proved true – till the weeds developed resistance. Now this GM crop needs nearly twice as much weedicide as the conventional crop.

Of course use of chemical sprays is a standard process for many modern farmers. Yet a closer look at Roundup does raise some concerns.

Glyphosate, the active ingredient in Roundup, has been found in Denmark’s drinking water at five times allowable levels. However, industry experts had expected glyphosate would be fully broken down by soil bacteria. Was there too much glyphosate for the bacteria to breakdown?

Though glyphosate is highly toxic to human cells exposed directly in the lab, its use pre-dates the Roundup formula by about two decades. Residue limits were established, as for other pesticides, to protect the public from high exposures.

Interestingly, the introduction of Roundup Ready crops meant that regulators in the US needed to increase the allowable residue limits by 3 times so the new system would not breach the limits!

How much is too much?

The non-active ingredients of Roundup make it more toxic than glyphosate alone. Roundup is at least twice as toxic as glyphosate to placental cells, even at concentrations 90% below those found in agriculture! (The placenta is the medical term for the afterbirth. Do note that these tests are done on living cells in a laboratory and not on live pregnant women!)

In an animal cell study, Roundup but not the active ingredient glyphosate, disrupted the cell cycle. The cell cycle is the routine of cell division used routinely by many types of body tissue for regeneration. Such findings lead to critics’ concerns that Roundup residues may add to cancer risk.

Roundup, unlike glyphosate, can penetrate leaves. Of course Roundup Ready crops are able to detoxify most of the herbicide within their leaves. But the ingredient which allows this penetration has been explained as the culprit that allows Roundup to penetrate human cells in the labs.

But are Caribbean consumers at risk? After all, though we don’t have tight regulation on pesticide use, we cultivate neither Roundup Ready soy nor canola.

Could there be Roundup Ready residues in the processed soy products we and our livestock consume? What about other Roundup Ready crops like canola or corn or beetroot? Are all residues washed off? As for the absorbed Roundup, do plants detoxify every toxic molecule in their cells?

Assuming Roundup is Safe, Aren’t GM soybeans and By-products Safe?

GM foods are classified as GRAS in the USA, Generally Recognized As Safe. The industry says adequate research has been done to assure us that GM food equals conventionally grown food in nutrient balance, allergy risks and safety.

Large scale trials involving human subjects are not required for GM foods to be approved in most countries and little industry research is available to the general public or even the independent scientific community.

So is the Anti-GM lobby just paranoid? Actually, the fears expressed are not mere speculation.

Early alarm bells were sounded by scientists not a paranoid public. Prior to 1999, allergy researchers in the UK found that soy allergies affected 10% of the public. After the introduction of Round Up Ready soy, that figure jumped to 15%. Later research showed that GM soy and natural soy had different protein profiles after all. Allergy to GM soy specifically (but not natural soy) was demonstrated by a real patient using skin prick testing.

One allergen was found to be 27% higher in Roundup Ready soy than in natural soy and heating did not breakdown the allergen.

If you and your loved ones are not prone to allergies you might shrug that off.

But what if you knew that mice fed Roundup Ready soy had abnormalities to their liver cells which indicated both increased cellular activity and increased activation of cell genes? These changes were reversible on switching the mice to non-GM soy feeds. (Phew!)

Russian studies from 2005 are also worrying. In three repeated experiments rat pups whose mothers were fed Roundup Ready soy before conception, during pregnancy and nursing and who were then weaned onto Roundup Ready soy, had a death rate five times higher than those fed non-GM soy. 221 rat pups were studied in these experiments.

Vital organs were smaller and body weight averaged 13% less for rat pups exposed to the GM-soy. Both pups and their mothers from the GM-fed group showed anxious and aggressive behaviour. The pups that survived were sterile (unable to conceive) till the females were mated with males who had been fed a non-GM diet.

Animal studies are typically done to look for red flags that could suggest human risk. It is unethical to perform such research on human subjects unless animal studies strongly suggest the safety of experimental products.

But until GM foods are required to go through both rigorous and independent studies we can only hope that we are faring better than the Russian rats.

*Whether soy added to the diet reduces or increases breast cancer risk is unclear as research findings have not been consistent. Though some women do switch to soy milk hoping to benefit this observation is not a recommendation. Nonetheless, soymilks labelled as ‘not from GM soybeans’ or ‘organic’ are available.

NOTES on SOURCE MATERIAL:-

The frontiers of genetically modified soya in Argentina. Posession rights and new forms of land control and land governance.1

12-10-2012  Lucía Goldfarb

International Development Studies (IDS-LANDAC), Utrecht University – Transnational Institute (TNI)

L.I.Goldfarb@uu.nl

Genetic Roulette The Documented Health Risks of Genetically Engineered Foods by Jeffrey M. Smith

Anders Legarth Schmidt, “Poisonous Spray on a Course Towards Drinking Water,” Politiken, May 10, 2003

Caroline Cox, “Herbicide Fact Sheet: Glyphosate,” Journal of Pesticide Reform 24, no.4 (Winter 2004)

Benbrook, “Genetically Engineered Crops and Pesticide Use in the United States: The First Nine Years,” October 2004

Caroline Cox and Michael Surgan, “Unidentified Inert Ingredients in Pesticides: Implications,” Environmental Health Perspectives Aug 18 2006

Sophie Richard et al, “Differential Effects of Glyphosate and Roundup on Human Placental Cells and Aromatase.”

Julie Marc, et al., “Pesticide Roundup Provokes Cell Division Dysfunction at the level of the CDK1/ Cyclin B Activation,” Chemical Research in Technology, 15, no.3 (Mar 2002): 326-31

EPA Rule, “Pesticide Tolerances and Food and Feed Additive Regulations for Glyphosate: Final Rule,” Federal Register 57 (1992): 42700

Mark Townsend, “Why soya is a hidden destroyer,” Daily Express, March 12, 1999

Hye-Yung Yum, Soo-Young Lee, Kyung-Eun Lee, Myung-Hyun Sohn, Kyu-Earn Kim, “Genetically Modified and Wild Soybeans: An immunological comparison,” Allergy and Asthma Proceedings 26, no.3 (May-June 2005):210-216(7)

Arpad Pusztai, PhD, personal communication with Jeffrey M. Smith

  1. Malatesta et al, “Ultrastructural Morphometrical and Immunocytochemical Analyses of Hepatocyte Nuclei from Mice Fed on Genetically Modified Soybean,” Cell Struct Funct. 27 (2002):173-180
  2. Malatesta et al, “Reversibility of Hepatocyte Nuclear Modifications in Mice Fed on Genetically Modified Soybeans,” Eur J Histochem, 49 (2005):237-242

I.V. Ermakova, “Diet with the Soya Modified by Gene EPSPS CP4 Leads to Anxiety and Aggression in Rats,” 14th European Congress of Psychiatry. Nice, France, March 4-8, 2006

Irina Ermakova, “Genetically modified soy leads to the decrease of weight and high mortality in rat pups of the first generation. Preliminary studies,” Ecosiniform 1 (2006):4-9

I.V. Ermakova, “Genetically Modified Organisms and Biological Risks,” Proceedings of International Disaster Reduction Conference (IDRC) Davos, Switzerland August 27th– September 1st, 2006:168-172

This article was first published in UHealth Digest April-June 2013, issue 21. It appears re-published on this blog in its originally submitted form.

http://www.uhealthdigest.com