Tuesday, 3 May 2016

Notes from Another Sphere - Part Two

Journal Entries from A Pre- and Post-Natal Counselor's Experience at A BBMP Hospital

Varsha Shridhar

March 17th

This time, Dr. D.M is not the senior consultant, as she is off on leave. Instead, Dr. S. T, a more junior consultant, leads the way. Something about Dr. S.T tells me that she might be a little more judgmental in her attitude than D.M. Perhaps it is her statement that “some mothers are so bad that they don’t even bring their kids to the clinic for their regular immunizations”, a statement that makes me wince a bit.
Dr. S.T has some good ideas, though. She starts off the clinic by introducing herself and the team. She tells moms the drill: get your baby weighed and measured here, get their shots there, then go visit the counselor (me) on that side of the room, and so on. She also spends a good ten minutes explaining the importance of washing hands before eating and cooking, and after using the toilet. Dr. S.T is Telugu, and speaks in Kannada. However, the majority of the clientele in this neighborhood is Tamil. How many people understand her instructions? God knows. But I appreciate her intention.
This time my group is a bit more diverse in terms of language. I find that conversing in Kannada is not as difficult as initially feared. I reiterate Dr. S.T.’s messages of hand washing with most of my patients. Then, one lady brings her baby and sits down. “Tamil or Kannada”, I carol at her. “Hindi”, she replies firmly and then launches into a stream of Urdu. I blink at her. “Huh?” I say intelligently. “Bacchan kal rath **gibberish** kha liya. Aaj polio ka daviyiyan doon?” (My kid ate **something** last night. Can I give him the polio drops?) is what I managed to understand after multiple attempts. No idea what it was that the kid ate. Was he supposed to have eaten it? Or was it some sort of garbage that he stuck into his mouth? I attempt to understand this. “Aapne khaneko diya?” (Did you give him this to eat?). “Nahin, vo apne aap kha liya” (no he ate by himself).
Okay. That didn’t get me too far. What exactly was this lady’s concern? Was it the fact that the kid had eaten something he wasn’t supposed to? (in which case, why wait till the next afternoon to ask someone about it?) Was it because she wasn’t sure if he could get an oral polio vaccine since he had something in his stomach (from last night - was she saying that he had had nothing to eat since he woke up? )? Was she asking my implicit permission to give him whatever it was that he had eaten? And how in the world was I supposed to ask all these questions if my brain couldn’t unscramble itself quickly enough for me to form any coherent sentences?
Overwhelmed, I say to her, “Aap vo doctorse pooch lo” (please ask that doctor over there).
When she leaves in a bit of a huff, I berate myself for my complete unpreparedness for a Hindi-speaking patient and spend a few minutes meditating on possible answers I could have given, wrack my brains for the right vocabulary (not too Sanskritic or Anglicized) and practice some lines in my head.
Next walks in a lady who overturns my idea of the people who use a BBMP PHC. She is attired in a frilly pink T shirt and jeans, heels on her feet, a perfectly well dressed little baby girl in her arms. We talk in English; she lives in one of the neighboring high rises; is worried about her daughter having a cold. As we chat, I notice bruises on her hands and realize that what I thought was a disfiguration on one of her cheeks is actually another bruise. “What does your husband do?, I ask, very casually. “He works too. My mother in law lives with us”, she says softly. I am not sure how to proceed. On one hand, the bruises could have a perfectly rational and harmless reason. On the other hand, why was such a well-dressed woman coming to a BBMP clinic, unless she felt this was one where probably not too many questions would be asked? On the pretext of playing with her baby, I watch her carefully. But honestly, I cannot read the situation. I have to send her on her way. How does one ask another woman, whom she has known for all of five minutes, if she is being abused by her husband?

Three women with a small baby seat themselves in front of me. “Weren’t you here a couple of weeks ago?” I ask, since the baby looks so familiar. “No, no”, they assure me. “Maybe your mother came with the baby then?”, I ask the woman in front of me. “No no”, she says. The baby is about nine months old and looks to be two months. I could swear it was the same baby from the last time I was in the clinic, the one whose grandmom ran away. But these women are firm that that is not the case. I drop the subject. Again, we talk about the baby’s weight; this time I ask more detailed questions about his development and diet. The baby has never tried to crawl, or sit, or even roll over by himself. He just keeps lying down. The mother gives him some biscuits and milk, but no vegetables or fruits or breastmilk. I talk about the importance of all this but I get the frustrating sense that I am not making much leeway. But the presence of the other two ladies gives me a false sense of security as I insist again that the baby be taken to the doctor. “Dr. S.T. is right here. Please take this baby to her. He needs help”, I say. “Yes, yes”, they all nod. I think that at least the other ladies will make the mom take the baby to the doctor.

An old Muslim lady rushes in. “Gassa ka goliya dedoji” (give me the gas tablets), she cries.
“Gassa ka goliya?”, I blink stupidly. “Kya gassa ka goliya? (What gas tablets?)”
“Vahi vo lal patte vale” (those ones in the red strip)
I dazedly gaze around the array of tablets on my table. I see Omeprazole, sodium citrate, some crocin and the like. “Vo vale”, she says pointing to the Omeprazole. I vaguely know they are related to some stomach issues, but that’s about it. “Main nahi de sakti aur main doctor nahin hoon. Aap vo doctor ke pas jao” (I can’t give you those and I am not a doctor. Go to the other doctor), I say.
“Dedona” (please give)
“Nahin ji, nahin de sakti. Vo doctor se poochlo” (no, I can’t. Ask the other doctor).
She looks a bit disgusted and disappointed and leaves.

Phew! This day has no end of surprises.

Just as I am getting up to leave, a mother walks in with a small girl and a baby in her arms and hands me the baby’s records. I look at the notes the pediatric resident has scrawled: Weight 2.1 kg (<2SD) meaning that the baby is very underweight.
We chat about the baby’s diet. Then, all of a sudden, the mom bursts into tears and sobs that she isn’t really worried about the baby, it’s her daughter who refuses to eat any food. She talks about how every mouthful has to be coerced; about every mealtime being filled with tears, frustration and rage; about the family’s collective exhaustion with this situation. The baby, she says, is fine. I ask her questions about diet: what does she give the kids, how many times do they poop and pee and so on. According to her, she gives them everything: bananas, raagi, meat, eggs, milk. Apparently the baby eats all this, but the girl does not. The girl too is very under-sized; a 3 year old who looks like she might not yet be 1.5. The mother says that she finds it difficult to bring the kids to the clinic or take them to the pediatrician in a nearby hospital. She is also afraid of going back there because she thinks the pediatrician will scold. I dismiss these concerns: no no, the doctor won’t scold. She may ask why you haven’t brought the kids to her for so long, but she’ll help, I tell her. While I explain to the mother that yelling and hitting at the kid during meal times isn’t going to get her to eat more, I know that some medical intervention is called for as well. I call the Pediatric resident, Dr. M, to evaluate the situation. Dr. M. checks the girl’s throat, asks even more detailed questions about diet (I learn that trick from her: ask what the patient has at EVERY meal, not just a general overview), asks about birth weight and so on. Dr. S.T steps into the room while this is going on and listens in. The doctors diagnose malnutrition and recommend that the lady take both her kids to Sanjay Gandhi Children’s Hospital, at least ten km away. While I agree with the diagnosis and the plan, I am taken aback by the attitude of the doctors. They are patronizing, they scold the mother for not having brought the kids to a doctor sooner (no wonder she had been procrastinating taking her kids to the other doctor! This attitude must be prevalent everywhere), they discuss her kids in front of her as though she and they weren’t present. At the end of ten minutes or so of all this, the mother takes her babies and scuttles out, not meeting anybody’s eye. I am pretty sure she’s never going to come back here again. “God, these people!”, says Dr. S.T. “They are so uneducated and backward”. Then she starts a diatribe about the backwardness, about how the husbands are useless, probably spending all the money on drink and cigarettes, about how they mistreat girl children and so on. I make “hmm… hmm” sounds as she talks, not wanting to give offense. But I feel terrible and small and more than a little lost. I think my actions today have driven away this woman and her kids without solving any of her problems, adding new ones to the mix. I hated seeing her shamed so, but I hadn’t said anything to help her out. I have no idea what I ought to have done, either.

A sobering end to my second day at the clinic.

Notes from Another Sphere - Part One

Journal Entries from A Pre- and Post-Natal Counselor's Experience at A BBMP Hospital

Varsha Shridhar

3rd March 2016

My first day at the BBMP Urban Primary Healthcare Center in Koramangala. I get there around 11am, by which time the clinic in in full swing. Babies are being measured, weighed and injected with whatever shots are deemed appropriate, mothers are chatting, the attenders in their blue sarees are ordering people about… a typical scene in a government hospital. I find my contact, Dr. D.M, inside one of the consulting rooms. She is marvelously efficient - within a few minutes, I have a spot at one corner of her clinic, a set of chairs around me, and the attender is leading in my first few patients.
I am an antenatal and postnatal counselor. This means I talk to pregnant moms and new mothers about their worries and concerns, I give them advice on nutrition, I counsel them on how to take care of themselves, their babies and their families. I speak to the family members, if they are present. I find out about their work, if they have help, if they have any ongoing issues with something, I help them problem solve. My role is to be a source of support, an elder sister of sorts.
My main source of worry on this day is my ability to communicate. I can handle Tamil, but Kannada and Hindi, I tend to falter with, despite being able to read both languages and have routine conversations. Oh well, I’ll muddle along somehow, I think.
I have done some homework for this trip. Just before leaving for the clinic, I send my various cousins a question on WhatsApp: How do you say, “don’t have unprotected sex” in Tamil, Kannada and Urdu. My cousins are highly amused and I spend the time while traveling to the clinic giggling at their increasingly improbable translations. Nonetheless, before I step into the clinic, I have my answer: Avar jothe serak mudhale nirod upayogisi (use a condom before sex). “Serodu”- to join, the colloquial euphemism for sex in Kannada and Tamil. Phew! I can embellish the rest.
My first patient brings in a baby of about three months old. As is my custom, I ask her which language she is most comfortable with, to which she replies, “Tamil”. I practically rub my hands in glee. We chat. She’s a first time mom, living with her mother, who has also accompanied her, a large capable-looking woman, who initially looks askance at my questions about diet and at my even more impertinent questions about urinations and bowel movements. But she thaws soon, once I praise her lavishly at the work she does everyday to keep her daughter and grandchild healthy. I ask my patient about her husband: does he visit, does he play with his child, does he spend the night and so on. “Never!” inserts the mother, at this point. “According to our custom, her husband will not sleep in the same room with her for the first seven months”. “Wonderful!” I assure the patient and her mother. “But in case the opportunity arises and you want to have sex, you must think about contraception”, I say, keeping my eyes fixed on my young patient. “Don’t become pregnant right away. Give some time to yourself and your baby to grow up” “And give some time to your mother”, her mother interjects, at which we all laugh. I tell her to go to Dr. D.M., who I see is relatively free at the time, and discuss options for contraception and am gratified when they head there directly afterwards. A very pleasant session indeed.
I see about 10 or 12 more patients, all Tamil, most doing relatively well. My only truly worrying case is a grandmother who has brought her 9-month-old grandson, but the child looks closer to 2 or 3 months of age. “Where’s your daughter?” I ask. “At work”, she replies. “I feed the child and take care of him. I give him cow’s milk”. Further questioning reveals that her daughter breastfeeds once or twice a day. The grandmother looks hassled, has very bad teeth, slightly blurry eyes, and difficulty understanding what I am saying. The baby is asleep. “You need to go talk to Dr. D.M. This child needs help. He doesn’t look well”, I tell her. She nods and gets up. My attention is momentarily caught by the next patient who walks in. When I look back up, she’s nowhere around.

The clinic closes at 1pm. The attenders walk us out, we get back into the ambulance that will take us to the hospital whose outreach program runs this clinic. On the way back, Dr. D.M and I discuss my experience. My most vivid impression of the two hours I have spent is of how incredibly diverse the clientele is. I have spoken to mothers who are day laborers, who work as receptionists and speak English, some who are fairly well educated and some who are illiterate. The phrase “government hospital” evokes images of lines of women carrying malnourished babies, wearing tattered sarees. In reality though, the PHC serves as a first contact for pretty much anyone living in the vicinity and this includes educated women and their families. What also stands out is that most of these babies look okay - other than the one who was clearly malnourished, most babies were decently sized, many were exclusively breastfed. What is more worrying is the standard of nutrition for the mothers. New mothers are not counseled on nutrition and most do not eat vegetables and fruits, with the result that most of them suffer from constipation; some are dehydrated.

Dr. D.M urges me to come for their antenatal clinic, since this is the time, she says, where counseling is desperately required, but no one available to provide it. I hesitate to commit because I don’t want to take on too many new commitments. I don’t want to stop going to the postnatal clinic, now that I have experienced it and feel it might be better to gain some mastery on one aspect before tackling another new one.

A good introduction, all in all, to the world of the PHC.

Friday, 11 March 2016

Reclaiming Birth Shakti

Reclaiming Birth Shakti

Mangala Ramprakash

Google "cesarean rate in Bangalore" and you'll find a slew of articles bemoaning the disproportionate rise of c-section births in urban India. There are a host of reasons given such as doctors being too busy and unwilling to dedicate the time and availability for a normal birth, lack of staff and infrastructure (even in the poshest hospitals) to attend to simultaneous normal births given their uncertain lengths, the financial angle, and the ubiquitous fear factor that lead both the doctor and expecting mother to settle for a controlled surgical birth. There are even some blame-the-victim reasons given by defensive doctors that women these days are too unfit, too unhealthy, too fat, too superstitious, too old, too posh to push.

It's a minefield out there for a woman looking to give birth naturally in a setting that is designed for the convenience of the staff and the hospital. Even in a "normal delivery", women are subject to clinical medical procedure, stripped of all joyful and transformative aspects of birth for both mother and baby. In contrast with how interior the entire process of conception and gestation is, modern industrial birth takes place amid glaring florescent lights, impersonal stranger hands and gleaming sharp instruments - reducing to a pitiless emotionless ordeal what should have been the highest manifestation of strength and glory in a woman's life. Instead of feeling empowered and ecstatic with a new realization of her own capability, a woman comes out of birth feeling diminished and dehumanized, with a vague sense of having lost an irreplaceable rite of passage that was her biological birthright. Like the petals of a rosebud peeled back by gloved hands in a laboratory instead of blossoming naturally where it has grown in the light of the sun, the miracle of life is routinely reduced to a standard business-like hospital procedure.

In her brilliant deconstruction of societal attitudes regarding birth and parenting, Naomi Aldort, author of 'Raising Our Children, Raising Ourselves', cuts right to the heart of the matter:

"Girls are shaped to grow up with no self-trust. They learn to believe that a doctor should “deliver” their babies. They are taught not to trust themselves and look for guidance from authority. They lost the ability to see themselves as the authority on their own bodies and birth giving.

"Our modern mother is well trained to look for cues outside of herself. She does not trust her own body, does not know to feel it and in a way is disconnected from herself. She assumes that the doctor knows and that she does not know how to give birth. She therefore believes she must be in a hospital and follow instructions (as she was trained to do at home and in school). She believes blindly the story that birth is scary, unsafe and not possible without a doctor in a hospital.

"In the hospital the mother who has been trained out of her self-awareness, is further stripped of any sense of being in charge and having power of herself. She follows instructions as she has been taught all along and is unable to recognize her own body wisdom. She signs her right off upon entering the hospital and she lays on her back (no power), often connected to machines, intimidated and with no privacy.

"Stripped of body connection and inner power the mother becomes helpless depending on external instructions and hopelessly believing the “experts” and “professionals.” She misses the real expert: herself."

The season of pregnancy and birth is often the most liminal period for a woman, fraught with the one deep burning question of her existence: will she choose to internalize all the fears and cautions and rules that the world in the form of her family, friends and doctor imposes on her and thus be circumscribed by limits she has passively accepted; or will she choose to have faith in her own authentic inner guidance against all odds even in the face of the world's naysaying? Will she gravitate towards the choice that will not get her blamed in case of a bad outcome, or will she accept the primary responsibility for her child's and her own well-being with the spiritual maturity capable of living with uncertainty and unknowing without giving up? This will determine whether she will birth in a self-directed manner, listening within, fully engaged in the process physically, mentally, emotionally and spiritually; or default to being "delivered" by someone else according to their agenda.

The choices and experiences a woman goes through during this period of her life often changes her whole ground of existence, because she is indeed giving birth to herself as a new being, a mother. The nature of this new identity she forges will have far-reaching effects on how she perceives herself, how she nurtures and parents, how she lives and moves in the world.

This places the responsibility of the manner in which the child is born into this world squarely at the woman's door. In a deeper sense, our experience is going to be our own state of consciousness objectified. Truly, we birth as we live.

Elizabeth Gilbert, author of 'Eat Pray Love', was asked in an interview, "What do you think the world needs from women right now?"

She replied, 

"I think the world needs women who stop asking for permission from the principal. Permission to live their lives as they deeply know they often should. I think we still look to authority figures for validation, recognition, permission.

"I see women who have this struggle between what they know is right, what they know is necessary, what they know is healthy, what they know is good for them, what they know is good for the work that they need to do, what they know is good for their bodies, what they know is good for their families - all too often ending that statement with the upturned question mark: “If it’s okay with everyone?” Still asking, still requesting, still filing petitions for somebody to say that it’s all right. I think that, myself included, that has to be dropped before we can take our place in the way that we need to and the world needs us to."

Swami Vivekanada stated more than a 100 years ago, 

"The idea of perfect womanhood is perfect independence"

and went on to say, 

"The highest manifestation of strength is to keep ourselves calm and on our own feet." 

Nowhere is this more relevant than in the domain of pregnancy and birth - womankind's exclusive privilege. And indeed, this warrior's journey from the "collective they" to the "authentic I" and onward towards the "compassionate we" is the consummation that all life tends towards.

Steve Taylor, PhD, professor of psychology at Leeds University, puts it this way, 

"I would argue that one of the most important tasks of our lives is to develop more freedom and autonomy. One of the primary ways in which we can develop positively and begin to live more meaningfully is to transcend the influence of our environment, and become more oriented towards who we authentically are. There is always a part of us with innate potentials and characteristics which is independent of external factors - even if that part of us may be so obscured that we can barely see it. But our task should be to allow that part of us to express itself more fully, which often means overriding environmental and social influences." 

This is very relevant to the fact that reclaiming autonomy in birth is not selfish or irresponsible or foolhardy as it is sometimes made out to be - it is an evolutionary imperative. It is the natural outcome of a rise in consciousness.

Talking of overriding environmental and social influences, Roopa Jude, founder and manager of the Bangalore Chiropractic & Wellness Clinic, is one of the few women in Bangalore to choose a homebirth for her second child. Her first birth was a regular hospital one that involved standard obstetric practices like prostaglandin gel, pitocin to speed up labour, and finally a forceps delivery when she was too exhausted from lack of food and rest to push. 

"The overpowering non-mother-friendly atmosphere in the hospital shuts down the body's auto mechanisms as far as birthing and labour are concerned. You are no longer listening to your body and along with the hospital staff become victims of the system, doing all the things that prolong labour and make birthing more difficult. You are denied food when your body craves fuel to gear up for the marathon effort of its life, you are confined to bed without the relief of movement even as the pitocin-induced contractions are pounding your body without let up, and you are subjected to frequent painful cervical checks by different doctors on shift. I was worn down by hours of this, and when the doctor finally produced the forceps, I was taken aback at how big and complicated the contraption looked. I was so exhausted from the delivery that I fainted several times during recovery. My only blessing was that I was not subject to a c-section at the end of it all which apparently would have been the norm, I was told, if not for the team involved in my case."    

Roopa connected with the BBN (Bangalore Birth Network), and met several natural-minded folks like chiropractors, midwives and a community of supportive like-minded women. Within her, a conviction started to grow that homebirth was the only way to birth with autonomy and bodily integrity. At about the same time, she discovered she was pregnant, and the hunt for a homebirth midwife was on. She found a nurse-midwife from Australia who happened to be in India for a year and got her on-board as her care-provider. Through the BBN, she found a doula and also support for her midwife who had never done a birth in India, let alone a homebirth.

Her path to a homebirth, however, was far from smooth. Her midwife was out of the country for a period of 3 months, and slated to only return on the day after her due date. At 34 weeks, urged by family as well as her midwife, she visited the family doctor who had delivered her first child. The doctor checked her and found that the baby was breech. Roopa was firmly told to come in and get admitted for an immediate cesarean if her baby had not turned head down by 36 weeks gestation, just 2 weeks away. Such was Roopa's unrelenting resolve not give up her dream of a homebirth that she never went back to the doctor, in spite of pressure by family and friends. Instead she researched natural breech births and was intent on birthing at home, regardless of the position of the baby.

"My husband and I had absolute faith that God, the Creator that had grown this child from a single cell to a full-fledged baby, would also take care of the way and manner in which it came out of my body", she states with serene confidence.

Roanna Rosewood, author of 'Cut, Stapled and Mended', echoes this sentiment, 

"The people and institutions managing birth have nothing to do with impregnating us. Our babies are a gift from something bigger, stronger, and more important than they are. The way that we choose to give birth is between us and the powers that entrusted us with this child."

Roopa and her husband at this point were simply taking it one day at a time.

At 39 weeks, a scan revealed that the baby had turned head down. But her happy ending was still not at hand. By week 42 she had still not gone into labour! Finally at 42 weeks and 3 days, labour began. She thinks it significant that just prior to the beginning of labour, she had an urge to sit down and polish off a heaping plateful of delicious pulav her mother had cooked, as well as a big bowlful of peanut pakodas. 

"I'd never eaten that much in my life before, and I generally don't like peanuts. My body was fuelling up for the effort ahead. All I did was follow its cues", she smiles.

A smoothfive hour labour later, she pushed out her baby on all fours in her own bed. "When the head came out, everything stopped for 30 seconds to a minute. The baby actually coughed and blinked while he was still inside of me. After this mini-rest which seemed like a lifetime to me, in one last powerful contraction, his body slid out into the midwife's hands. He was so clean, hardly covered in vernix, and very alert, already looking around and taking it all in. The midwife said she was compelled to award him a 10/10 Apgar score because she had never seen a baby so perfect in skin tone, muscle tone and alertness immediately upon birth", recalls an elated Roopa. She did not even require stitches post-birth, and her recovery was stress-free and peaceful as the family bonded happily with the new arrival. She remarks, “Finally, the whole process gave me insight on how women in ages past could give birth to so many children. It is a very empowering experience that leaves no distaste for a repeat.”

This is the choice that lies before women at this critical juncture of time - will we continue to look outside for cues on how to lead our lives, or will we manifest shakthi, the innate power of womanhood, in every movement of our lives, including the profound responsibility of how we bring our children into this world? It is time women took that responsibility back. It is time women owned birth again. It is time women manifested "soul-force" as Martin Luther King, Jr. put it, something that emanates from a deep truth inside of us and empowers us to act. 

The most gracious and courageous gift we can offer the world is our authenticity, our uniqueness, the expression of our true selves. Go ahead. Unleash the goddess within!

Tuesday, 26 January 2016

Breastfeeding: The Basics

What Everyone Should Know about Breastfeeding
Deeksha Sharma
  1. Like all mothers you can successfully breastfeed your baby, which is the most natural way to feed babies.
  2. Breast milk is complete nutrition (i.e. food and drink) for an infant for the first six months of life. During this period, an infant needs exclusive breastfeeding and no other food or drink, not even water, is required.
  3. Newborn babies need to be given to the mother to hold immediately after delivery. They should have skin-to-skin contact with the mother and begin breastfeeding within one hour of birth.
  4. Colostrum, the first yellowish mother's milk that comes during the first 2-3 days after birth is the first immunization. Nothing should be given before the first breastfeed.
  5. Babies should be breastfed unrestrictedly, day and night, and on demand. Breastfeeding the baby frequently causes production of more milk.
  6. Breastfeeding helps protect babies and young children against dangerous illnesses. It also creates a special bond between mother and child. No pacifiers should be given to the babies. You can continue breastfeeding during your or your child's sickness without any harm to the baby and yourself.
  7. Bottle feeding and giving a baby breast milk substitutes such as infant formula or animal milk can threaten the baby’s health and survival. If a woman cannot breastfeed her infant, the baby can be fed expressed breast milk or, if necessary, a quality breast milk substitute from an ordinary clean cup.
  8. A woman employed away from her home can continue to breastfeed her child. She should breastfeed as often as possible when she is with the infant and express her breast milk when they are apart so that another caregiver can feed it to the baby in a clean and safe way.
  9. After 6 months of age, when babies begin to eat foods they need a variety of additional foods. Home-made, family food is better than commercial food for your baby.
  10. Breastfeeding should continue for up to two years and beyond because it is an important source of nutrition, energy and protection from illness.

All women have the right to an environment that protects, promotes and supports breastfeeding, including the right to protection from commercial pressures to artificially feed their babies. The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 as Amended in 2003 (IMS Act) aims to provide the necessary protection by prohibiting the promotion of all breast milk substitutes, feeding bottles and teats.

Further reading: 10 facts on breastfeeding: WHO; July 2015

Wednesday, 6 January 2016

Fertility Awareness

Venetia Kotamraju

When I was at school, at a mixed boarding school in England, many if not most of us were on the pill by the time we left aged 18. Once you turn 16 in England you are entitled to a free supply of the contraceptive pill, subject only to a routine and regular check up by your GP. Some were on the pill to regulate periods or to clear up acne, but for many of us it was just something we started to take as soon as we entered the realm of sex. The terrible spectre of teenage pregnancy was forever before us. It would mean the end of our education, the end of our career prospects, and that pretty much meant the end of life as we knew it. So if there was even the slightest chance we might get into some kind of sexual situation at some point, even if it was just a drunken fumble on the walk back from the pub, it was better to be safe than sorry. Condoms too but you couldn't rely on them nor on the testosterone-fuelled teenager you were with, so to the pill we turned.

We knew about all the different types of pills, patches, implants, rings and barriers, but we had no idea about the magical events that were taking place every month, or would have been if we had let our bodies' natural rhythms continue undisturbed. Periods were something to be endured, something ugly and rarely discussed even among close girl friends. The rest was biology. The idea that our menstrual health was a huge part of our overall physical, emotional and mental health, and that our cycles were something to be respected and celebrated was an idea completely foreign to us.

Nor were we ever made aware of the far reaching impact of taking such contraceptives on a regular basis for years and decades together. The doctor would check our blood pressure, ask about deep vein thrombosis and that was about it. If one pill made you break out in spots, you simply switched to another type. Perhaps doctors were not aware then - perhaps they still aren't today - but several articles I've read recently link the long term use of such contraceptives to depression and other mental health issues. And of course, when we finally got to the stage where we actually wanted to get pregnant, after years of seeing it as the Most Terrible Thing Ever, many of us found it wasn't so easy. Those same friends who were on the pill for years to prevent an unplanned pregnancy are now taking artificial hormones to try and achieve a pregnancy, and many are struggling.

But could there have been an alternative? Other than abstinence of course.

Well as it turns out yes. Had we been introduced to and taught what is called the fertility awareness method we might not only have been able to steer clear of these type of contraceptives altogether, but we might also have found ourselves much more comfortable in our developing bodies.

Fertility awareness or natural family planning is most definitely not the rhythm method, because it is based on reading your body not a calendar, but it stems from the same idea. Figure out which days of the month you are fertile and then avoid those days, or focus on those days if you're trying to get pregnant. It aims to make you body literate by teaching you to read the signs your body gives at dfferent stages of your cycle each month: temperature, cervical fluid and cervix position, as well as other secondary signs such as breast tenderness.

By tracking these signs and noting them down - charting as it is called, and there are now apps to make it even easier - you soon know how your own cycle works, whether you're ovulating or not and when, how long your cycle is normally and thus whether your period is late, whether that's cervical fluid or an infection (as Toni Weschler points out in her book Taking Charge of Your Fertility, many people who have thought they continually had some kind of vaginal infection realise that it was in fact completely normal variations in cervical fluid). It also helps account for more subtle changes that earlier would have seemed random and thus more difficult to manage, that broody feeling you get just before your period as your body sub-consciously mourns the child that has not been conceived, or the sudden surge in libido as your body prepares to ovulate and the corresponding dip after ovulation, and of course the much caricatured PMS.

Ultimately, practising fertility awareness allows you to avoid pregnancy without having to resort to contraceptives and all the issues they bring - those in long term relationships who don't have to worry about STDs can finally ditch condoms too - and also improve your chances of achieving pregnancy when you want to. Indeed, just by understanding when you ovulate, which is all too often not on day 14 as almost all doctors tell you (that is just the average figure; many women have shorter or longer cycles, and ovulation can vary from cycle to cycle too), you can massively increase your chances of conception without having to start what can be very intrusive fertility treatment. And as a bonus, when you do get pregnant you will be able to help your doctor get the delivery date right; so often doctors predict a delivery date which is too early - because they take it from the date of your last period and use an average cycle length of 28 days to calcluate - and that can lead to women being unnecessarily induced because they are 'overdue'.

The pill was heralded as a wonderfully liberating tool for women, but by artificially regulating our cycles it robbed us of control over and appreciation of our menstrual and overall health. Fertility awareness puts us back in charge, bringing us fully in tune with the wonderful way in which our reproductive system works, allowing us to have sex for pleasure or procreation - or both - as we wish.

If only the NHS would dish out books on fertility awareness to the 16 year olds queuing up in its clinics, instead of oral contraceptives.

Taking Charge ofYour Fertility - Toni Weschler (probably the best known book on the subject, with a huge amount of details and discussion about common menstrual disorders such as PCOS and endometriosis). NB: this book is now available in the BBN book library
Ovagraph app for charting (the official charting app for Taking Charge of Your Fertility)