Music I Want My Child To Listen To - Political Passions

Not so much a specific band for me this week, but a concept that transcends genres. Inspired by the political mood of the nation this week I'd like to instil a passion for politics in my children and music has been such a powerful tool in communicating political messages throughout the decades. From the Sex Pistols to Chumbawumba to Ani DiFranco to Faithless, many bands and artists have woven political statements into their music and some have even inspired entire generations to action.

I'd like my son to appreciate the concept of political music, even if he can't relate to the themes, messages or genres that have influenced me. I'd like him to give them a chance though, maybe feel some sense of continuity with the passions of days gone by, though I desperately hope there won't be repeats of the riots of the 1970s and 80s, or of the global political events of the last 10 years, but I dare say the raw essence of the issues will repeat themselves: People against the actions of the state.

I don't know what the political mood will be like in 10 to 15 years time, when my son is discovering his own generation's music for the first time. I do know that there will still be musicians writing about it though and I promise not to condescend my son's choices with statements that begin "In my day..." Maybe he will be able to show me something new that we can share.

I tried to think of something more current as an example for this, but drew a blank. I kept coming back to Self Evident by Ani DiFranco, a song about 9/11 and its aftermath. It's a song that still deeply moves me and this issue is undoubtedly the single most important one of my generation, the political actions that led to those terrorist attacks and the ramifications of them still echo across the globe today and will for years to come. So I leave you with a fan-vid set to Ani's beautiful and powerful poetry.

Add your own blog for this meme this week to the Linky here: Alexander Residence

Give Me A Cure For Political Apathy

I don't normally listen to radio phone ins. They drive me bonkers. For some reason, the members of the public that the shows producers pick to speak on air are almost universally ignorant peasants. Often the supposedly "expert" guests are no better. However, on Friday, my husband and I were on a long car journey and were listening to BBC Radio 5 Live in the run up to Nick Clegg's speech on the Alternative Vote (AV) referendum. It was the usual rubbish, exactly what you would expect from a political phone in. People speaking who had no idea what they were talking about, a hill-billy type who was calling for a general election every 12 months in order to shake things up; someone who only wants to vote UKIP and doesn't want to pansy about with numbers on the ballot paper and so on.

But one woman really got my goat. She was given the opportunity to speak in favour of AV, she sounded really positive, if a little naive and said it was about time there was an opportunity for change and she wants to be able to put a tick on her ballot paper instead of a cross (AV doesn't work like that, there are no ticks or crosses required, just numbers). But generally she was upbeat and inoffensive. Then she was asked about political apathy and why people today often don't exercise their right to vote (around 40% of people don't vote in general elections in this country, turnout for local and European elections is even worse). Here she lost me. She said that she didn't vote, that all politicians are the same and that no amount of reform would change that. Sigh.

I really cannot stand political apathy in and of itself, but what I really dislike is the hypocrisy of political apathy coupled with complaint. I don't approve of compulsory voting. I think people have as much right to abstain as to cast a vote and that in some cases abstaining in itself makes a point. It is this very fact that has brought us to the point of even having a referendum on reform, the people who have been not voting in droves have been listened to by the Liberal Democrats and other political reformists and they want to find a way to engage those people with the political process again.

BUT, if you don't vote, then in my opinion you do relinquish your right to bitch to yourself, your friends, the internet etc about the decisions that politicians make. If you haven't voted and have no intention of ever voting or campaigning in any way for changes that you believe would be better for our country, then you have absolutely no right to whinge about the decisions that get made. You have chosen not to exercise your right to vote, you have chosen to disengage from the political process so when politics has a negative impact on your life, be it because of cuts to benefits or a rise in taxes, or cuts to the NHS that mean your local doctor's surgery can no longer run a drop in surgery, or school class sizes soaring to 35, whatever it is, shut up. Or get off your backside and do something about it.

Contrary to popular opinion, not all politicians are carbon copies of one another. Local MPs and councillors are often very approachable and engaged with their constituents. There are service user forums and committees to join, petitions to sign, letters to MPs to write stating what you do and do not approve of. The government IS accountable to the people and it DOES listen, sometimes it takes a lot of voices shouting in unison and the big things are very difficult to change, but you do have a voice and if you choose not to use it then follow your own precedent, and keep quiet if you don't like what comes of it.

Music I Want My Child To Listen To

So, I just encountered this meme for the first time and thought "Hell yeah! I wanna join in!" Music is where my heart has always been. I guess it's taken a bit of a backseat for a couple of years but I regret that and I'm hoping this will give me the incentive to get back into music. Recently I've been listening to some old favourites while I write, partly to help inspire my writing but also taking a trip down memory lane, following the recent photo storm among my old school friends on Facebook.

But I can't really start there, I have to go further back. Where did my love of music really take root? Easy, in the folk festivals my parents took me to as a small child. Most of the time spent at these folk festivals I was off playing with other kids, exploring and occasionally curled up asleep on, or sometimes even under a chair, while my parents watched the bands and artists perform. However, distraction and sleep both became impossible whenever Spirit of the West came on stage.

I remember the way the tiny platforms that formed a stage at some venues would shake under the thump of the bass drum and the weight of the lead singer jumping around. The whole floor would erupt with energy and enthusiasm, with otherwise stationery crowds leaping from their seats to dance to this high-energy band. Once, I even got sung to directly, having requested my favourite song (what band can't resist a cute 6 year old girl with pigtails who loves their music?!)

Spirit of the West are a Canadian folk band, who still occasionally do the rounds of folk festivals in North America. Their album Save This House still warrants the odd airing in my house now, twenty-odd years after it's release and the last time I saw them live.

Home For A Rest is one of my all time favourite songs, though obviously I didn't understand it as a child! Amid the frantic flute play, chaotic chords and lyrics about being drunk for a month there is an understated poetry, especially in the line "The spirits we drank are now ghosts in the room".

Here's a clip so you too can savour these Canadian delights. Enjoy.

Induced and left alone to birth in a toilet? True.

This rather alarming news story came to my attention today.

http://www.nottinghamwired.co.uk/news.php/124340-Kings-Mill-hospital-ignored-toilet-birth-mothers-calls

A couple in Nottinghamshire have reported that their daughter was born unattended in a hospital bathroom in November and that staff ignored when they pulled the emergency cord for urgent assistance. Apparently the midwives assumed the labouring woman wanted a cup of tea.

Let's skip right over the part where the midwives are implying that a labouring woman should be ignored when in need of refreshments, and move right on the the extremely distressing part of this story: that an emergency call from a woman undergoing induction was ignored.

Any call for immediate assistance for a woman in labour should be responded to, by somebody, anybody. Regardless of how frequently women in that birthing suite pull the wrong cord or hit the wrong button when all they need is a drink. The staff cannot assume that it is a benign matter, not for any labouring woman. But induction is risky. It is a risky procedure whenever and wherever it is done, in some cases the risks are lower than the risks of staying pregnant, but there are still risks. Ignoring an emergency call for a woman undergoing induction is, quite simply, negligence.

This isn't the first time I have encountered women who say that they were ignored during induction, that their requests for pain relief were ignored or that they were told they weren't yet in labour without even being examined. I even heard of one woman once who hadn't even been moved from the ward to a birthing suite and delivered on the ward floor on her own in front of half a dozen other women. Disgraceful.

This recent case is a little scant on details. We know that the midwives assumed that the labouring woman only wanted a cup of tea, so deemed it unnecessary to attend to that need. I might have a little more sympathy for the midwives if it transpired that they were very short staffed and no one could be spared for non-urgent care (forgetting again that it is clearly wrong to just assume that the emergency cord has been pulled for non-urgent reasons). But only a little sympathy can be garnered from such an excuse. If the ward was so short staffed, why induce? Why willingly fill up the ward when there aren't enough midwives? When birth can be scheduled (Ha!), why do so in full knowledge that there are not enough midwives available to attend to every woman both in spontaneous labour and booked for induction?

Perhaps this woman's induction really couldn't wait a day or two. Perhaps she had a true emergency reason for needing to get the baby earth-side. And here we are back at the point that she was ignored in an emergency situation.

There is no winning scenario for the staff on duty at this hospital that day. Either there was someone available to answer the emergency call but it went ignored anyway, or the ward was too busy and so the inductions should have been postponed where possible, or finally, the induction was for genuine medical reasons and therefore the woman was in need of close attention.

The couple have received the standard NHS response to complaints: "We are sorry you feel this way." It isn't a true apology. They are not taking responsibility for their mistake. They are not genuinely sorry for the deep trauma they have caused. They are not attempting to put anything right or change their services for the benefit of those who come after this couple.

It's not good enough. It's never good enough.

Part of the reluctance to take responsibility is fear of litigation, the same fear that causes hospitals to line up increasing numbers of women for unnecessary inductions. As nonsensical as that sounds, it's true. Hospital administrators want to try and control birth, because if they control things and things go wrong they can claim that they did everything possible to prevent it. In doing this they don't stop to ask if they cause more harm than good.

Birth cannot be controlled or scheduled. Sometimes things go wrong, yes, but in a culture of true woman-centred care, where the woman knows and trusts her midwife and where medical intervention is reserved for hose who truly need it ,I somehow think that the growing litigation culture wouldn't be a significant factor because even on the rare occasions that the outcome is negative, the people involved will know and trust their care providers. I'm sure that the reason people lash out and try to sue the NHS now is because they are upset with the level of care shown, they want someone to take responsibility and apologise properly. I know that's true of me and many of the women I have met who have grievances against hospitals for their maternity care. A genuine apology would settle many a dispute before it even reaches the point of hiring lawyers.

A lesson many hospitals would do well to learn.

A Frightening Future for Maternity Services

In December the government announced that they were going to go back on the promise made in July that maternity services would be commissioned by a national board and that they were going to hand over commissioning to GPs. When the White Paper came out there was a great deal of praise from every relevant body, including the Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynaecologists (RCOG). It was widely recognised that maternity services need to be commissioned nationally in order to ensure the best care in every area and in order to work efficiently with neonatal services. While other commissioning was going to GPs, it was acknowledged that GPs have very little experience or knowledge of maternity health and are primarily focussed on treating ill people, whereas pregnancy is not an illness.

However, GPs complained, they stamped their feet and said the idea was "stupid". It has been suggested that this is basically about money. GPs know they don't have the expertise but are afraid of losing out on some funding if they don't get to control the purse strings.

The government bowed to this pressure and have now handed over commissioning to the GP consortia.

Since the decision was announced, Cathy Warwick, general secretary of RCM has been very vocal in the press about the bleak future of maternity services. Midwife shortages, lack of choice for women and their families and GP interference are of grave concern and she has been trying hard to get the message out there.

This article in the Guardian on Saturday sums it up well. Basically, lives are at risk. The government is falling short on its commitment to maternity services. I love Cathy Warwick and I am so glad she is speaking out, but there were a few things about this article that concerned me.

The title image was one of them (see top of page). A newborn baby being held by a woman in scrubs, presumably a midwife, in an operating theatre. Hardly an image of normal birth. Perhaps the point was to negatively depict the current situation? Dangerously high caesarian section rates, complete medicalisation of birth that can only get worse with GPs at the helm. However, I doubt many readers would interpret it as such, my suspicion is that this image will only perpetuate the idea that this is what birth is and has to be, bright lights, clinical, operative, the mother not even depicted - not important.

But this image was only an afterthought for me.

The article makes reference to the number of currently enrolled student midwives, a figure that the government is throwing about in order to defend itself against allegations of not honouring promises to increase the number of midwives. I've seen it a lot lately in response to Cathy Warwick. What I have yet to see is any journalist drawing attention to the low retention rates, midwives are leaving the NHS in droves because of poor working conditions and then there is the little matter of the recent government decision to lift the tuition fee cap to £9000 per year. How many student midwives will withdraw from courses now that they can no longer afford the fees? How many prospective midwifery students, both school leavers and older people looking to retrain, are now rethinking their plans? This figure really can't be relied upon as an indicator of how many midwives we can expect to see working within the NHS in the coming years.

The main thing about the article that sent chills up my spine was the final quote from Steve Field, the former chair of the Royal College of GPs (RCGP). The article states

Professor Steve Field, former chairman of the Royal College of General Practitioners, said the new maternity networks which will be set up in England as part of the government's contentious NHS reforms should improve the quality of care. "Maternity care is not as good as it should be," he said. "But GPs, working with obstetricians and patients themselves, should be able to design better patient-centred services."

Two things about this frighten me. The first is his referring to pregnant women as "patients", which demonstrates his general attitude towards pregnancy, i.e. that it is an illness to be cured, rather than a natural biological condition and that most pregnant women are not ill. Secondly and even more alarmingly, the lack of midwives from the consultation process. At best their exclusion here is an unconscious omission based on Field's lack of understanding of the important role of a miwdwife in pregnancy and birth. This is the very reason people fear GP commissioning. They simply don't understand maternity care provision. How can they go forward from this place of no comprehension? How can they do it without consulting with midwives? This is the best case scenario. The worst is that he is aware of what midwives do and RCGP is actively planning to marginalise midwives from maternity service provision.

There are GPs practising in the UK today who are demonstrating absolutely appalling lack of knowledge on normal birth and of midwifery led care. Make no mistake, these people are NOT the people we want deciding how the money gets distributed. For a recent discussion between maternity service users on GPs see here.

Choice

On Thursday, obstetrician Maggie Blott, from the Royal College of Obstetricains and Gynecologists (RCOG) spoke on BBC Radio 4's Woman's Hour in a feature on pregnancy and birth, she stated that some women do not have a choice in where (and one must assume, how) they give birth.

The feature was generally very good and well balanced, I have no complaint with the BBC over this. The host, Jenni Murray was her usual calm and collected self, giving equal floor time to all of her guests. Sheila Kitzinger, founder of NCT and Birth Crisis, author and all around birth activist was interviewed and was asked about choice, birth plans and even orgasmic birth. A woman who had had a home birth recently was interviewed with her midwife and they both talked about how wonderful the experience was. The midwife was enthusiastic about home birth and talked about how rewarding her job was, which was refreshing coming from an NHS midwife, who are so often beaten down and jaded by the hideous system within which they have to work.

The issue of maternity services commissioning came up, following the Royal College of Midwives (RCM) recent conference, at which general secretary Cathy Warwick criticised the government for their U-turn on this topic. In the White Paper released in the summer, it was announced that while much commissioning would go to GPs to be determined on a local level (quite rightly so), maternity services would be commissioned by a national body. The reasoning for this is that maternity services is not generally dealing with people who are unwell, so is therefore outside of a GP's field of expertise. It is also something best looked at on a national level, because where complications do exist in small numbers not every local authority is going to have the resources to fund expensive facilities for very rare cases. It needs to be looked at on a larger scale so that the best provisions for those who need more care can be made in a sensible fashion. For example, not every local hospital needs a maternity unit and Special Care Baby Unit (SCBU), but at least one major hospital per region does need this. If commissioning is local then how will these facilities be funded?

However, some GPs inexplicably came out against this decision and have lobbied the government with such spurious arguments as "this is stupid". Hmm, helpful and how professional.

Cathy Warwick appeared on Woman's Hour and presented the case against GP commissioning. Health Minister, Anne Milton was also interviewed and she stated that no decision has yet been reached and that all sides were being considered. The general feeling among those in the know is that the government is going to come down in favour of the GPs. Why are the GPs even interested in this? What is in it for them? What does it mean for women and their families if their GP practice decides to reduce funding? The whole ethos of choice and quality care is under threat. It will become a postcode lottery as to whether a woman and her family can enjoy the essential quality of care that she needs. Women may end up having to travel large distances to receive their antenatal care if community midwives are made redundant by GP practices and the choice of where to give birth flies swiftly out of the window.

Which brings me back to the opening of this post. In the UK we are lucky to be able to exercise our fundamental human rights without fear from the government. Mostly. We are much better off than some countries. The Universal Declaration of Human Rights (UDHR) stipulates in Article 3 that "Everyone has the right to life, liberty and security of person." Security of person relates to the body and the mind, so basically every person has the right to bodily autonomy; they decide what happens to their physical body, and has the right to protect their emotional and mental wellbeing and no one has any right to override that autonomy. It would be under this fundamental human right that choice in birth comes. Every woman has the right to choose how and where they give birth. It may be that she has certain risk factors that may incline her care givers to recommend one place over another, but ultimately it is the woman's choice to take or leave that recommendation. For instance, an intense phobia of hospitals may mean that a woman chooses an elective caesarian in order to be able to plan the date and time of her birth and to control the amount of the time spent in that environment. Or it may mean that she chooses to give birth at home, perhaps even on her own with no midwife present if her phobia extends to hospital staff. That is her right.

During my first pregnancy I had no "risk factors". I was totally free from any medical-based prejudice towards one location or another for my birth. I was lucky enough too, to live in an area that nominally supports and encourages home birth. Unfortunately, there are so few women in this area choosing to birth at home that the midwives are not as skilled and experienced in normal, un-medical birth as they ought to be and as such, I was given a medical birth at home, which was never going to end well. Now I do have "risk factors". Next time I am pregnant, the NHS will "advise" me to have my baby at hospital. Not because it is what is statistically safest for me and my baby, but because their protocols are set out by a team of lawyers with the paralysing fear of being sued forever at the forefront of their minds. They want to control and manage all risk, rather than simply dealing with problems on the rare occasions that they do occur, so that they can say "we knew this was a risk and we tried to avoid it".

However, what many women genuinely do not realise is that they still have their fundamental human rights, as protected by the UDHR. They can decide for themselves whether to take the advice they are given or not. Because I am well-informed and have taken a great deal of time and effort to research the risks for myself and to analyse the reasons for protocols and guidelines to be in place, I know for myself that not only can I still have my next baby at home if I want to, but that there is even an official guideline that tells maternity personnel that I can make that choice. There is a NICE Guideline that states that women with one previous c-section should be treated no differently from any nulliparious woman (someone expecting their first child).

So, when I hear an obstetrician from RCOG on national radio stating that women with a previous c-section, for this was one of several specific examples that she gave, "do not have a choice in where they give birth" I am furious. Not only is she stating that some women do not have their fundamental human rights for the sole reason that they are pregnant, she is also going against the guidelines she is otherwise so tied to!

Midwife Cathy Warwick was wonderful at this point in the interview and did intercede to state that women do still have a choice and should be supported in that choice even if she has risks that her obstetrician is unhappy with. However, my fear is that Maggie Blott has given a green light to her colleagues to lie to women in their care. I know that the practices of lying and coercion are already very common in maternity care, from my own experience and those of other women I know, but to hear it on national radio from a member of RCOG has had quite an impact on me.

I urge women and birth activists everywhere to not let this go by without comment. Tell your friends, relatives, strangers in the waiting room, that being pregnant does not strip a woman of her human rights! Write to RCOG and demand a formal public apology for Maggie Blott's comments. I will be doing just that.

And on the subject of maternity services commissioning, please write to your MP as a matter of urgency and demand that the government stand by its commitment in July. The final decision on this is due in just a few weeks so there is no time to lose. You can find contact details for your local representatives here: http://www.writetothem.com/

Guess the Weight

Guess how many sweets are in the jar, or better yet, guess how much the sweets inside the jar weigh. Not including the jar itself but including all the sweets you can't actually see in the photo....

I'll give you a little help, you see that green one near the top left? Well the distance from the highest tip of that sweet to the lowest tip of the red stripy one down the bottom is... let's say 25cm. NOW tell me how much the contents of the jar weigh.

What? You mean you can't work it out?

No, I couldn't either, neither can my mathematically gifted husband. Although he does argue that he is familiar with these kinds of sweet jars and would therefore be able to estimate that the sweets weigh 1kg. But he is missing my point a bit.

From looking at this picture alone, with one arbitrary measurement and without being able to see maybe 80% of the sweets in the jar, there is absolutely no way that with this information alone anyone would be able to estimate with any degree of accuracy how much the sweets weigh. My husband is right though, using his life experience, he can guess the weight fairly accurately. But we do know with some degree of certainty that these exact sweets were weighed before putting them in the jar prior to sale. The same cannot be said of a baby in the womb.

So why do so many people believe a sonographer when they say that their unborn baby weighs xlbs in utero? It's the same sort of equation. An ultrasound gives the sonographer a view of a small section of the uterus at any one time and gradually builds up a picture as the transducer is moved across the abdomen. Three measurements are taken during a growth scan, the biparietal diameter (distance between the 2 sides of the head), femur length and the abdominal circumference. These measurements are entered into a computer program which then calculates the estimated weight based on charts created by researchers. You would think it would be fairly accurate. All that science.

The problem is that for one, the scan is only as good as the sonographer. All humans are capable of error. What one sonographer measures one day may be totally different to what another sonographer measures the next (on the same woman and baby). I have even heard of one sonographer giving a woman and her obstetrician quite a fright by writing down measurements that implied that her baby had SHRUNK! That was human error, babies don't shrink, as the obstetrician quite rightly pointed out, and later apologised to her and admitted that a mistake had been made.

But also, who made these charts and from what research? My best guess is that researchers have measured aborted and miscarried fetuses in order to establish average lengths, diameters and circumferences at different gestational ages. I wonder how many samples they looked at before coming up with these charts? From how many different ethnicities? Did they account for growth abnormalities in unhealthy fetuses?

There is a wonderful bit of research that demonstrates the complete unreliability of growth scans in late pregnancy:

Pregnancy outcome following ultrasound diagnosis of macrosomia.
AUTHORS: Delpapa EH; Mueller-Heubach E
AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, University of Pittsburgh, Magee-Women's Hospital, Pennsylvania.
SOURCE: Obstet Gynecol 1991 Sep;78(3 Pt 1):340-3
Extract: "In 66 of 86 women (77%) delivering within 3 days of ultrasound examination, estimated fetal weight (EFW) exceeded birth weight. In only 41 of these 86 women (48%) were the EFWs within the corresponding 500-g category of birth weight."

So basically, this study (admittedly only a small one), found that 77% of growth scans predicted a higher birth weight three days BEFORE birth, so if these scans really are as accurate as we are led to believe then 77% of babies shrink in the last days of pregnancy. See above. More alarming is that 48% of scans, i.e. less than half, were accurate to within 500g, which is more than 1lb. What a large margin for error! The difference between a 9lb baby and a 10lb baby can be a HUGE difference to the mother and her care providers both psychologically and in terms of her care during late pregnancy and birth. To look at it the other way, more than half of scans were LESS accurate than that. 52% of women scanned were expecting either much bigger or much smaller babies than they got.

Why does it matter?

Because if a midwife sends a woman for a growth scan because of concerns late in pregnancy, and the obstetrician that the woman sees after her scan decides that, based on this one scan, her baby is too big or too small, then interventions may be advised that are simply not necessary. For example, if a baby is suspected to be too big, early induction or c-section will be advised. Except in the current NHS system the woman will come away thinking that it is not advice that she has been given, but an order to comply with.

Why does it matter?

Because interventions without clinical need are a waste of resources and may have long-lasting negative effects on the mother and baby. Caesarian sections are known to leave babies with more breathing problems, greater risk of diabetes and cause risk factors for the woman in future pregnancies, never mind the risk of post operative infection and post traumatic stress disorder.

Why put women through that? Why subject a woman at the end of her pregnancy to fears about the wellbeing of her baby? Even when the prediction of a too big or too small baby is accurate, how often does it actually mean ill health for the newborn? According to one study, "Our ability to predict macrosomia is poor. Our management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome." (My emphasis).

The Delpapa and Mueller-Heubach study above also concludes that "A trial of labor resulted in vaginal delivery in 76 of 106 women (72%). There were five cases of shoulder dystocia but no birth trauma. Estimated fetal weights and birth weights were not significantly different between the women who had a trial of labor and those who did not. Our results do not support cesarean delivery or early induction as a means of preventing infant morbidity when fetal macrosomia (weight of 4000 g or more or the 90th percentile for gestational age) is diagnosed by ultrasound."

So ultrasound is NOT an accurate estimate of fetal weight and even when a baby is genuinely large (4000g+), spontaneous labour and vaginal birth are still the safest option.