Monthly Archives: January 2013

Book Review: Bumpology, by Linda Geddes

Bumpology is an attractive and accessible book with a very clear and logical layout, which compensates for the lack of an index. It is as easy to dip into as it is to read from cover to cover; I know because I did both.

This is a marvellously comprehensive collection of research evidence and occasional comment upon the lack of research evidence, for all the advice and received wisdom relating to pregnancy, birth and early parenthood. As Geddes says, the science is out there, but it often takes some digging to find it.

Geddes looks at the big issues such as place of birth, breastfeeding, and all those things you’re told you can’t eat during pregnancy; as well as bringing in some colourful sections on how the growing baby develops in the womb, what senses function from birth, and the role of newborn reflexes. This in itself is a useful part of learning to empathise with the baby, and might influence parenting choices.

I am used to reading far more dogmatic books (from all over the birth and parenting spectrum), so this measured tone is very refreshing. Research in this area on the whole appears to be very thin, often studies are very small or based on the behaviour of lab animals. The book does not offer many definitive answers, but its general message is not to take advice for granted, since much of what we are told from the moment we even start to think about having a baby has no basis in fact. This very important point was made by Octavia Wiseman in a recent Midirs article (July/August 2012:p22), pointing out that much health advice is risk-averse, undermining parental choice, and that “explaining to women the limitation of our evidence base is the first step to take when asking them to make ‘informed’ choices.”

It is lovely that the text is scattered with anecdotes about the author’s personal experience, but for the most part this book is about facts not feelings. It largely ignores ‘soft’ aspects such as how parents feel about risk, and how mothers experience birth and early motherhood. Statistical comparisons of different aspects of birth look at outcomes and define those in terms of health of the baby and mother, taking little account of how women feel during and after the experience. For example lying down or being mobile during labour may make no difference to the outcome in statistical terms, but different women may experience these scenarios as more or less positive. Lying down in a room full of medical staff may feel disempowering; a woman being made to walk around may feel bullied. Working with parents both antenatally and postnatally, I know that scientific evidence may not always be the most important factor when making decisions. A good example of this would be the decision to share a bed with your baby: whether, according to various studies, this increases the risk of cot death; or whether it increases your child’s self-esteem, are less likely to influence the decision to bedshare than the fact that it might just be easier not to have to get up in the night. This does not, of course, detract from the fact that parents can and should be made aware of the evidence in order to make an informed decision; and to be fair, Geddes does not set out to explore the qualitative aspects of parenthood, but to present the facts and figures, and bust the myths: a very worthwhile mission.

Geddes’ personal bias against antenatal teachers comes across in the book, but as this is what motivated her to write it, I’m choosing to view this as a positive thing!

I would recommend Bumpology to anyone expecting a baby, but I think it is also essential reading for anyone working with parents, antenatally or postnatally. It is so important for us to get our facts right, to counter the myths and enable parents to be confident in their decision making. Very few of the books I’ve seen are so robustly evidence-based, and an awful lot of people working with parents will repeat advice without giving any critical thought either to the evidence behind it, or the effect it might have in an individual situation.

Bumpology Blog
Sense About Science
Linda Geddes on Radio 4’s Today Programme with Belinda Phipps, CEO of NCT

Originally posted here on 15th January 2013.

“A healthy bout of chickenpox”

There has been, and I hope there will continue to be, much written across new and old media about the risks of not vaccinating children and about the tide of misinformation about those risks.

Whilst reading the arguments and counter arguments, I often hear the suggestion that some of these childhood disease are “harmless”, such as in the recent book Melanie’s Marvellous Measles and in this passage from Jayne Donegan, the controversial GP and friend of Andrew Wakefield:

If you look carefully at children after they have been supportively nursed through an infectious disease, you will always see them do something new, depending upon their age and circumstances. An infant may produce a tooth; a toddler who kept banging into things will walk confidently; a six-year old who is not reading will suddenly start to read. It is rather like a snake that has to crack off the old skin before it can grow, children go through these crises of self cleaning before they can move on to the next step. I have often seen children with endless snot or lots of warts have both of these cleared by a healthy bout of chicken pox. Such infectious diseases do not improve the population, in the harsh Darwinian view of things, by killing off the weak and leaving only the strong ones to reproduce; they actually give each individual child the opportunity to strengthen their own individual immune system and make the best of what they have.

Whilst 16 weeks pregnant with my younger sister Jenny, my Mum caught chickenpox (I’d picked it up from a party and passed it on). Following Jenny’s birth it quickly became apparent to my parents that something wasn’t right. Over the next couple of years my parents spent countless hours in hospital waiting rooms and Jenny was subjected to test after test.

We now know that between 12 and 28 weeks of pregnancy there is a 1.4% chance that chickenpox in the mother would cause Fetal Variella Syndrome (FVS). That Jenny’s GP at the time was unaware of this and that Jenny’s problems took so long to be diagnosed caused much frustration and distress and are, perhaps, a separate issue.

Jenny at Cropredy
Jenny at Cropredy

The FVS had disrupted Jenny’s brain and eye development. She has large calcium deposits particularly in the left side of her brain. This has caused a myriad of issues, most notably a hemiplegia (basically cerebral palsy on one side of the body), severe learning difficulties, and she is has cortical blindness in her left eye and limited vision in her right.

Despite her problems she is basically a happy soul and her pure joy whilst dancing at a folk concert is a sight to behold. However, Jenny will never be an independent person, never get a job, or achieve the milestones that most of look forward to in our lives. She will never be able to make a decision for herself about her future.

The issues around deciding when, and where, vaccines are appropriate are complicated and I don’t write this as a call for any change to policy. Decisions in public health shouldn’t be made on the basis of testimonials, but I would strongly argue against dismissing these diseases as ‘harmless’ when they can, and do, cause death and severe disability. Complications from chickenpox are rare, deaths are thankfully even rarer, but for Jenny and my family the complication rate is 100%.

Jenny & me
Jenny & me