25 Oct 2012

Why I wear a poppy

 If ye break faith with us who die
We shall not sleep, though poppies grow
         In Flanders fields.

It's 2012, 98 years since the outbreak of the First World War, or Great War as it was once known. All the veterans are dead now. Few civilians survive who could give any account of it and as such, it slips from the national (and international) consciousness. It stands alone, a military campaign like no other.

Almost ten million soldiers died. That equates to the entire population of Hungary.

Just under one million of those were British. Imagine now, if a million young men were wiped out of our population. Everyone would know someone who died, and since 1914, the population has risen by a third. Only 52 parishes in England and Wales had all their men returned. No parish in Scotland or Northern Ireland was unaffected. The scale of the devastation is absolutely unimaginable these days, when every dead soldier is reported on the national news, and given full military burial honours. 435 British soldiers have died in Afghanistan since 2001. Over 400000 British soldiers died, or were injured in a 19 week campaign at the Somme, in addition to another 60000 German soldiers.
The only member of my family that I categorically know was involved in the first world war was my great grandad, who was invalided out with a shrapnel wound. The leg was later amputated. I know that all my great grandfathers would have been in service, though that particular one is the only one whose story I know. Your great grandfathers would have been too, because of conscription. Conscription - when you are legally required to sign up and fight - was introduced halfway through the war to try and bolster numbers. However, the sheer weight of moral expectation to sign up made conscription largely pointless. The healthy men had all signed up, only those in poor health and essential work were left.
And the healthy men were decimated.

In 1920, the remembrance poppy was introduced by an American women called Moina Michael, who was inspired by the poem In Flanders Fields. Field Marshall Haig adopted the idea for the Royal British Legion in 1921, and they have been sold ever since, from the end of October until Armistice Day and Remembrance Sunday. The funds generated go towards providing support and care to veterans of conflict, no matter where or when they fought. The RBL have received criticism for taking donations from the BNP and Tony Blair. The RBL's work, while admirable, is not the reason I wear a poppy.

Some adopt the poppy as an aggressively nationalist tag, claiming it as a symbol of British pride. They argue for the right to wear their poppy, which nobody has ever disputed outside the world of diplomacy and international football. Yearly, the rumour mill claims that Muslims are trying to stop people wearing poppies. Yearly, the rumour mill is wrong, and yet it still inspires so much racism that it makes me ashamed to be British. The poppy is a highly unpopular symbol in Northern Ireland, yet this doesn't create half the ignorant, ridiculous ramblings of idiotic racists, bellowing abuse in the name of 'patriotism'.
Nationalism is not something I identify with. It is not the reason I wear a poppy.

I am vehemently pacifist. I don't idolise soldiers, I don't deify the military dead, I don't glorify war. Neither does the poppy appeal.

The reason I wear the poppy is simple. In 1914, a war started that the common man could get involved in.
So, they were fed into a system of trenches, barbed wire, tanks, mustard gas, shells and bullets. They lived in mud, they suffered from trench foot, lice and diarrhoea. If they suffered shell shock, they were court martialled and shot. Millions died. There was no post traumatic stress counselling for the survivors. Families were devastated, children left fatherless, women left to cope. Those that were lucky enough to survive came home and they carried on. Some carried injuries for life, like my great grandad. Some never recovered mentally. Not one was left without a scar somewhere, in body, mind or spirit.

I wear my poppy to remember that it must never happen again.

They shall grow not old, as we that are left grow old:
Age shall not weary them, nor the years condemn.
At the going down of the sun and in the morning,
We will remember them.

22 Oct 2012

Informed choice and dissent in post-term induction of labour

Recently my little sister gave birth to her second baby. She was 42 weeks pregnant exactly, and had a spontaneous natural labour, that she described as peaceful. Her little girl was a healthy weight, and is absolutely beautiful.
However, the day before her labour started naturally, she was admitted for a routine induction of labour, which she refused. Despite saying repeatedly to her own midwife, the midwife on the phone and the midwife on the assessment ward that she did not want to be induced, she had to see an obstetrician to make sure she understood the risks of refusal. And that obstetrician did what all obstetricians do when women refuse induction solely for being overdue: she pulled the "YOUR BABY WILL DIE" card. Luckily, my sister refused to be scared, had a normal placental flow scan and was discharged. Her labour began properly the following evening and she had a quick, painkiller free delivery. I am VERY proud of her.
I had my second child at 42 weeks gestation as well. I was due to be admitted for an induction (which I did not want) a few hours after he was born. I had an exceptionally fast labour and when he was born, he was shown to have two knots in his umbilical cord. Not only could this have killed him at any time from around 14 weeks of pregnancy, if my membranes had been ruptured, he would have become distressed and I would have had either a caesarean or stillbirth. Instead, I had a natural birth at home, exactly as I'd wanted, and he was born healthy.
 My mother's sixth child (the sister mentioned above) was 19 days late before she was finally browbeaten into an induction, however she was already in early labour. Her EIGHTH child was twelve days late, when the obstetrician on call asked her if she wanted her baby to die, to try and force her into an induction. Considering my mother's seventh child was a premature stillbirth, this was incredibly cruel. My youngest sister was born safe and happy 12 hours later. 

Are there risks associated with overdue babies? Yes, of course there are, or it wouldn't be an issue. One study shows that at your due date, in a normal pregnancy, your risk of stillbirth and neonatal death sits at 0.24%. By 43 weeks, it has increased to 0.58% (Hilder, 1998). A much larger, longer case study was done in Scotland, which put the mortality rate at 43 weeks at 1.15%, as opposed to 0.22% at term. The baby, being presumed more mature, may pass meconium in labour, which may poison them. However, this is not exclusive to overdue babies.There has been a Dutch report that suggests there is increased likelihood of ADHD in postterm babies. (NHS choices, 2012). Otherwise, aside from fears of large babies, postmaturity syndrome, and placental problems, there are few risks associated with prolonged pregnancy that do not exist in ALL pregnancy.

However, although the NICE guidelines are that pregnancy should not progress past 42 weeks, and suggests induction of labour in these circumstances it also states that "Women with uncomplicated pregnancies should be given every opportunity to go into spontaneous labour." and "if a woman chooses not to have induction of labour, her decision should be respected. Healthcare professionals should discuss the woman's care with her from then on." (NICE, 2012). It also advises that induction of labour should not be offered solely because of likely macrosomia (NICE, 2012), otherwise known as a big baby.

My sister had previously told her midwife that she was uninterested in an induction, and was told that the last patient who'd done that had died, along with the baby, in a teepee in the garden. She then asked my sister if she was also planning on giving birth in a teepee. When I told my midwife that I did not want to be induced, she shrugged, said she had to follow protocol (in booking it) and that it was up to the consultant. A friend (who delivered under the same midwifery team as me) tells me how her midwife was equally surprised at her induction refusal and implied it was the consultant's choice.
Another describes her delivery team as: "I was given the impression that they thought I was a silly little girl for wanting it my way and that I'd change my mind and do what they wanted me to do."
Another women said "It didn't feel like a choice at all, just something I was told was going to happen. The actual process of breaking my waters was done without my prior consent - I was led to believe they were simply examining me."
Informed, unpressured consent in the small pool of women I consulted happened in just under one third of the cases. All women described an amount of expectation, and pressure that they would conform to having an induction.Several described having to demand the information on the procedure and risks, rather than it being given as a matter of course.

What of the risk in being induced? Induced labours are markedly more painful than natural, as the body is being forced to do something it is not ready to do. Induced labours can also be much slower, which in natural labour is not much of a problem - you just carry on until you're fully dilated, unless you want to be augmented with hormones. However, once the induction process begins, you are on a timer, and if your body fails to do as it's told, more intervention is necessary to bring forth the baby.
Both of these factors can cause problems with the labour. Painful labour often means an epidural, an epidural means lying around in bed, and that slows labour down. The labour is then not progressing fast enough for doctor's, who start considering instrumental or caesarean delivery. One study quotes a threefold increase in risk for induced labours to end in caesarean, versus spontaneous delivery (Thorsell et al, 2011). There is not a lot of data available for perinatal mortality rates in induced vs natural post-term labour, however one study suggests that induction does not reduce the mortality rate (Wennerholm et al, 2009)

A due date is an estimation. Unless you have a patient who knows categorically when she concieved (for example, in an IVF pregnancy), it is difficult to know when a woman ovulated, when the sperm met the egg, when the egg implanted. Early gestational scans make the dating process much more precise, but the five days for error allowed in them means the difference between being considered 9 or 14 days overdue. Not all babies who are supposedly overdue are born with postmaturity syndome. My youngest certainly wasn't, and he could not have been less than 11 days overdue by my dates (14 days by scan), though he did have a most luxuriant mane of hair. Equally, my new niece does not display the features of postmaturity syndrome, and she was at least 14, if not 17 days late. Babies do not all 'cook' at exactly the same rate.

When the NICE guidelines advise that women are fully counselled in the risks associated with continuing the pregnancy, or inducing it, they do not also advise belittling, or ignoring the woman's preferences; or scaring her with statistics. Quite the opposite: the woman is supposed to be informed and supported in her choice between induction and natural labour.
We need to find out why this is overlooked so frequently. Do obstetricians genuinely believe that they will have a flood of stillbirths on their hands if they allow women to go more than ten, or twelve, or fourteen days overdue? Or are they trying to control an otherwise uncontrollable natural process? Are we going to end up like certain parts of the USA, where inductions are booked before the expected due date is even reached, to fully medicalise the process? Inductions are not cheap: they require drugs, monitoring, observation, and bedspace, and like any birth, can require surgical intervention at any time. However, with the increased likelihood of interventions, is it cost-effective to panic women into induction of labour before 42 weeks has even been reached?

Women deserve informed choice, especially when they are on the cusp of undergoing a physically and emotionally demanding delivery. They do not deserve to be frightened or coerced into any procedure, least of all one as life-changing as birth.

Hilder, (1998) 'Stillbirth and infant mortality births in term and post-term gestation'  http://www.nice.org.uk/nicemedia/live/12012/41260/41260.pdf
Smith (2001), 'Perinatal death at term and post-term' in http://www.nice.org.uk/nicemedia/live/12012/41260/41260.pdf
NHS Choices (2012) http://www.nhs.uk/news/2012/05may/Pages/overdue-post-term-babies-adhd.aspx
National Institute for Clinical Excellence, 2012 http://publications.nice.org.uk/induction-of-labour-cg70/guidance
Thorsell, M,. Lyrenas, S. Andolf, E. and Kauser, M. (2011)  'Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women.' in Acta Obstetricia et Gynecologica Scandinavica; Oct2011, Vol. 90 Issue 10, p1094-1099
Wennerholm, U. Hagberg, H. Brorsson, B. Bergh, C. (2009) 'Induction of labour versus expectant management for post-date pregnancy. Is there sufficient evidence for a change in clinical practice?' in Atta Obstrecia et Gynecological Scandinavica; Jan2009, Vol 88 Issue 1, p.6-17
- Women's opinions and statistics gleaned by the author, from a brief online survey, comprising 13 participants between October 18th and 21st 2012.

18 Oct 2012

"I didn't mean YOU!" Oh yes you did...

"I wish I could sit on my fat arse watching Jezza all day, like those benefit dossers"

"There is another feckless actor in this dysfunctional family drama — the mother, who may be having children by a series of different men." (Daily Mail, 20th June 2011)

"Get rid of benefits and make the lazy scum work"

"My taxes pay for you to sit on your arse"

"In 2009, 6.7 per cent of the households in Britain were led by single women with children under 15, or older children still at school or college." (Daily Mail)

"By conceiving, [young women] are willingly making themselves unemployable and should receive reduced benefits!" (Daily Mail reader)

"Although single mothers don’t automatically mean filthy ignorant feral underclass scum offspring, the vast majority of filthy ignorant feral underclass scum offspring spawn from single mothers."

These are some opinions I have found on the internet about those nasty, evil, benefit scroungers. There are millions of others, usually voiced on Facebook by people who are barely above the underclass they revile. "FUKIN DOLE DOSERS SHUD GET A JOB!" is the illiterate howl of those who consider facebook a valid place to voice prejudiced hate, regardless of who might be reading.
As a dreadful dole dosser, I take these frustrated cries of the overtaxed very personally, and respond, only to be told "Oh, we don't mean YOU. We know why YOU'RE on benefits and you're OK".

Why? I'm not some sort of special case. I had my children relatively young, getting pregnant at 23 and then again at 25. Not a teen mother by any stretch of the imagination, but certainly younger than many of my peer group. My children have the same father - my former husband - and have a good relationship with him. I didn't choose to be a single parent, I was abandoned. At no point did it occur to anyone involved that my ex should get custody of the children, because that is not the way society works. Neither do we have joint custody, because that wouldn't work either. So, I am literally left holding the baby. I gave up work because it wasn't financially viable, if I also wanted to look after my kids. Some women can do it, I'm not one of them.

It suits the government to push this image of the young woman, using her womb as a mealticket, but the truth is somewhat different. Most women become single parents through desertion or death: few indeed decide to simply BE a single mother.
For a start, having children is INTENSELY hard work, even more so as a single parent. The knowledge that if something goes wrong, you're on your own, is tremendous responsibility. The ultimate job of a parent is to keep the child alive until adulthood. If you begin to fail to do this, social services rightly take your child away. I miss work because it gave me an opportunity to get away from that ominous responsibility for a few hours a week, as well as be recognised as a person other than 'Mumma' and get some adult company. When my eldest had a vomiting bug early this year, I did not leave the house or see another adult for six days. Six. Days. Single parenthood is isolating, difficult and exhausting. It is not something vast amounts of young adults choose. It is certainly not something I would have chosen.

The single mum, in her free house, surrounded by a variety of children with different fathers persists as the default image of single motherhood. It's not true. For a start, getting a council house is a massive ballache, often involving periods of either living in an overcrowded house with extended family or living in a hostel until a house becomes free. In Peterborough, there are about 1000 council houses up for auction each year, but a waiting list of 3000. The alternative is private renting, but this is a headache too because landlord's HATE benefits claimants. Most letting adverts bear the ominious "NO DSS". I have no idea why they're allowed to be so prejudiced, but it is their fault that social housing is so in demand. I privately rent, because I got my house before I technically stopped work. If I'd waited til my maternity pay finished, I would have struggled.

That is the real core of living on benefits: everything is a struggle. Benefit provision is at subsistence level. They give you the minimum you need to live, according to their research. I have enough to live on, purely because I can't drive. I do not get enough money, even with child maintenance factored in, to run a car. Most people consider a car essential to maintain an average standard of living. Not I! Every purchase I make has to pass the 'do I really need this?" test. If the answer is no, and I haven't paid the rent yet, it doesn't get bought. This extends to things like repainting the living room, buying a hedge trimmer to sort my front garden out, and even buying clothes. If I splurge, I feel guilty. Food prices are soaring, and when a bunch of bananas costs almost as much as a Happy Meal, you can see why so many people on benefits have such a dreadful diet. The worst thing for expenditure is energy. I have a gascard meter. It costs me about a pound an hour to have the heating on, and if I run out of money in the night, the gas keeps running, putting me into debt. Since I moved into a dual-fuel house, my energy bills have tripled. The choice is to have cold kids and more money, or warm kids and less money. The gas meter wins, every time. Trying to achieve the basic trio of shelter, heat and food is not easy on a low income. I often hear people say they are too proud to be on benefits. When you have children to look after, there is no such thing as pride. If my pride had stopped me claiming benefits, I'd have been homeless two years ago, despite being in work.

When people assume that everyone on benefits is on the highway to luxury, it makes me angry. When people assume that everyone on benefits is a workshy, babyfactory, that makes me angry. And when people say "Oh, we don't mean YOU", I get REALLY angry. The stigma extended to those on benefits is universal, from the top down. I get blamed by the government for the deficit, I get patronised by the jobcentre, I get judged by my son's preschool (because he has subsidised lunches), and everytime someone bitches about dole dossers, I get insulted. 


Now, you'll all be pleased to know that I've finished K101 and am now moving onto K203, which will doubtless mean less benefit-related bitching, and more perceptions of childbirth bitching.

10 Oct 2012

The Conservative Conference

The government like cuts. They REALLY like cuts. Someone (with a lot more patience than I) has compiled a list of all the cuts here. It makes for disturbing reading. The services that are being cut are primarily in the health, social and education sectors, and almost nobody will be unaffected by them. We're all in this together, according to David Cameron. However, it soon becomes apparent that this Utopia is quite Orwellian. We may be all in this together, but some are more in it than others.

For example, George Osborne wants to cut 10 BILLION pounds EXTRA off the welfare output, to rebalance the deficit. He thinks limiting the amount of children a family on benefits is allowed may help this. How, exactly, I'm unsure. I have two children. They were concieved before I required benefits to live on. If I'd managed to have five children without needing assistance, and then found myself needing it, would I be expected to have a cull? Put some in care, maybe? What is an acceptable amount of children for Mr Osborne? Two, like him? Or four, like Mr Cameron?

This country needs to stop punishing the poor (who are in increasingly less position to be able to contribute to the economy at all) and start taxing the rich. Our economy collapsed due to the greed of bankers, playing games with the country's money, yet mansion tax was scrapped because, apparently, it will soon spiral out of control, and people who have saved and worked hard will resent having to pay for their houses. Their enormous houses, that they cannot possibly NEED, that use up huge swathes of land. A worthy target for taxation.

However, the con-dem party aren't interested in this viewpoint. It is preferable to pretend that the enormous amount of people living in poverty are to blame. Iain Duncan Smith declared that "Now we are toughening up the penalty for failure to seek work." (BBC News). How does he define failure to seek work? There are no jobs to be had for many people, and most jobseeking benefits ARE stopped if you fail to seek work.
He also said "Gone must be the days when governments spent money to buy their way out of a problem." (ibid) but this is the problem. The only way to fix the amount of people on benefits is to invest. Invest in creating jobs, in improving areas of deprivation, in removing social exclusion. A child born into a debt-ridden, workless household will only have that to aspire to, unless social change happens.

This government are deliberately targeting those without a voice, in their benefit cull. The rich spoke out in droves against mansion tax, and were heeded. The poor have no choice but to accept cap after cut, because the government own us. In blaming us for the recession and deficit, the government are alienating and excluding us from society.

However, that's no longer enough and they're beginning to attack the workers as well. The minimum wage for over 21s (because, despite paying tax, you're not an adult til then in the government's eyes) is just over £10k a year. Can anyone live on that, without help? Can anyone support a FAMILY on that, without help? No. Yet, there's no call to introduce a living wage, and working families are resentful of those on benefits because they apparently have more money. This isn't true: for a childless adult, working is more profitable than being on income support. When I was a single, working parent, I got £200 a month more than I do now, overall.
In addition to this, Mr Osborne wants to remove people's employment rights. How humanitarian of him! Instead of allowing people to be protected from unfair dismissal, be permitted maternity leave, training and have a right to redundancy, they will get er...shares in their employing company. Aside from the legal ramifications of trying to enact this, it reduces employees to money-magnets, not people.
The new target is childless people under 25, who dare claim housing benefit. Apparently, these people should continue living with their parents. At what point did 25 become adulthood? At what point did income tax and national insurance start only applying once you reached 25? Oh, that's right, it doesn't.

The coalition government has no sense of what it's like to live in the lower classes. Instead, they fear and blame them and increase the distance between us and them, hoping that nobody notices. Legal tax loopholes mean that the rich are not paying into the economy, only taking from it. There is no push to close these loopholes. Instead, the lowest strata of British people are punished repeatedly, and vilified.This is not an acceptable way to run a country.

3 Oct 2012

Victim blaming and child abduction

Victim blaming is a concept more usually associated with rape. A woman goes out in a short skirt, she gets raped, she was asking for it. A woman gets drunk, she gets raped, she shouldn't have got drunk. Instead of blaming the man who chose to rape her, she is blamed for putting herself in his path in the first place. The insinuation is that the perpetrator could not help it, and it was the woman's fault. It is a dreadful reaction.

However, since the abduction of April Jones, I have noticed the same response repeatedly, aimed at her parents. The child was out playing with a friend after school, and someone abducted her. Those are the bare facts. The fact the child was only 5 and playing outside at 7:30pm has horrified some people. One person on my facebook list went to far as to accuse her parents of neglect and say that if April is found alive, she should be put into care. Many others have simply asked "Why was she playing outside so late?" The insinuation is clear: her parents are to blame for letting her out to play.

Now, hang on a minute. Your thoughts on what is an appropriate age for a child to play out late will be entirely subjective, based on where you live. There's no way my two would be allowed out where I live: it's a busy road and I don't know many neighbours. However, in my old village, I'd have been more than happy to allow them out to play with schoolfriends.
7:30pm seems late, but again, it's subjective. If you're still in 'summer mode' (which I certainly was until a few days), you may not realise how late it is, or think "ten more minutes won't hurt" or "I'll just finish this job and then I'll go and get her".

It's all completely irrelevant. It would not make any difference if the child was playing out at 3pm or 3am. Nothing gives a person the right to abduct a child. A child is not a dropped five pound note, that you might consider picking up if no clear owner was evident. A child is a small person, and whoever abducted her did so with grim intent. If she hadn't have been out, it would have been a different child, or maybe he would've waited and snatched her at a different, more socially acceptable time.

When  Myra Hindley, murderer of at least four children, was asked by a journalist why she abducted, raped and murdered Lesley Anne Downey, she replied "It was her mother's fault. She shouldn't have been out so late."

Victim blaming is merely a way to detach yourself from the horrors of what has likely happened to that little girl. Abduction is any parents worst nightmare. The guilt her mother must feel right now is far beyond anything most of us can comprehend, or would ever want to be able to understand. Stop blaming the parents, start blaming the monster who knows where she is.

1 Oct 2012

Exam nerves

I just laid on my bed and ate a massive cream cake from Greggs, like a decadent Northerner. And why (aside from the fact that cake is great) I hear you ask? Because, dear reader, I am procrastinating. Like a boss.

My exam is in fifteen days. I haven't sat a formal exam since June 2002, when I did my AS levels. I always did far better in exams than coursework at school, so technically this should cheer me (I got a coursework mark of 69% overall). I am not cheered. I am petrified.

The exam is three questions, in three hours. There is a choice of question in each section, one on each block of the course. In short, I 'only' have to revise seven units instead of all twenty three (although, some people are revising all of it in case they don't like the questions that come up). My eldest is now at preschool, so I get two and a half days without him. However, my youngest has decided that if I look busy, he wants to sit on my knee. Even as I type, he has clambered up to sit with me.

So, I'm panicking. I'm anxious and stressed and tired. I wander about the house bellowing Bowlby's theory of attachment. I have made cue cards about important topics, for one of the two big blocks I need to revise. I keep telling myself I'll be fine, I need 40% to pass, there's no pressure to push for a distinction, I just need to pass. But still, my mind flails around shrieking.

My next module starts on Saturday, and the first TMA (a thousand words on perceptions of health) is due on Halloween. Gawd help me.