Appendix A Announcement of Toby’s Birth
Ciaran and Bianca McHale, Reading: 26 February 2012
Dear relatives, friends and neighbours,
Our son Toby was born at 5:17am on Friday 17 February 2012. We know that many friends and relatives will have lots of questions to ask. So, rather than repeat the same conversation lots of times with different people, we decided to put all the details in a letter, and to put a copy of that letter on the Internet at www.CiaranMcHale.com/Toby/.
So far, Toby (at nine days old) is very placid, comfortable with strangers, and rarely cries. His main hobbies are sleeping, breastfeeding and filling his cloth nappy. Occasionally, he manages to squeeze a fourth activity into that hectic schedule: carefully studying his surroundings and people who talk to him. We all enjoy co-sleeping at night.1
Why did we choose the name Toby? Simple: we like the sound of the name. Toby is a friendly name. It makes you smile. By the way, the name is spelled Toby rather than Tobey.
You sometimes hear of women who have a miserable time during pregnancy: they frequently suffer from morning sickness, are bed-ridden with pain, find it difficult to walk, and so on. In contrast, Bianca’s pregnancy was remarkably trouble-free. Perhaps this was due to her having a healthy diet (well, aside from chocolate, that is). Or perhaps it was due to her having lead an active lifestyle over the past few years—swimming, jogging, cycling around town, and so on. Or perhaps none of that matters, and it was just due to genetic good luck. Whatever it was, Bianca thoroughly enjoyed her pregnancy, from conception right up to a few days before giving birth.
Ciaran and Bianca are sometimes regarded as being a bit “unusual”: eccentric or weird are terms that pop into people’s minds. Sometimes people describe us as committed, but we suspect they really mean that we should be committed. Bianca lived up to her “unusual” reputation during pregnancy. Lots of people were shocked to see a heavily pregnant woman cycling (she last cycled the day before her waters broke). But what they failed to realise is that, when you are pregnant, cycling is significantly easier and less tiring than walking.
In the first trimester, Bianca was enjoying her pregnancy so much that she started to feel a bit sad that she had not (yet) experienced morning sickness. Then one day, she did get sick. Ciaran, being a caring husband and always sensitive to Bianca’s needs, said, “That must make you happy.” Yes, Ciaran can be sarcastic too.
Ciaran has the following pieces of advice to offer any men whose partners are trying to get pregnant:
- When you are trying to conceive, you need to buy some pregnancy tests. Buying a test kit in a pharmacy or supermarket for, say, £5 does not seem like much of an expense. But if the first test indicates that your partner is not pregnant, then she might decide to wait a few days and take another test. And another. And another. What if you have to try to conceive for several months or years before striking it lucky (it took us three months)? You might end up having to buy a lot of pregnancy tests, so the cost of all those pregnancy tests can mount up. Because of this, I was delighted when I saw that a local discount shop called Poundland was selling two pregnancy tests for £1. That worked out to be just 50p each! So, my first piece of advice is this: visit discount stores to save money.
- Never let your partner know just how cheap the pregnancy tests were to buy. Rather than admire your money-saving skills, she is likely to be angry at how little you apparently value her and the new life the two of you are trying to create.
- If you do make the mistake of boasting to your partner how cheap the pregnancy tests were, she will eventually forgive you when she finds the same tests for sale in a pharmacy for £7.99.
Bianca and Ciaran read lots of non-fiction books as a way to learn about new topics. So it wasn’t a surprise that, when planning to have a baby, Bianca compulsively read books about fertility, pregnancy, giving birth, breastfeeding, and other related topics. And since we are subscribed to an Internet-based, DVD rental scheme called LoveFilm, we were able to rent some obscure DVDs on such topics.
Although not all of the books and DVDs were equally good, overall this self-learning approach turned out to be remarkably useful. It meant that we did not have to blindly trust the advice of healthcare workers, but rather could compare their advice to that in books. When the two sets of advice agreed, we could gain trust in the healthcare workers. And when there were discrepancies in advice, we were able to ask questions to clarify the issues.
If you are planning to have a baby, then, to save you the bother of having to sift through lots of books to find the best ones, Bianca recommends the following:
- Taking Charge of Your Fertility, by Toni Weschler. This book is a goldmine of information about female fertility.
- Anything written by Sears and Sears. This married couple have looked after eight children of their own and thousands of others in 30 years of paediatric practice. Their books are full of well-researched, useful advice. So far, Bianca has read The Pregnancy Book, The Birth Book, The Breastfeeding Book, The Baby Book and The Attachment Parenting Book.
- New Active Birth: A Concise Guide to Natural Childbirth, by Janet Balaskas.
- Three in a Bed: The Benefits of Sleeping with Your Baby, by Deborah Jackson.
- The Politics of Breastfeeding, by Gabrielle Palmer. From the back cover: “Every thirty seconds a baby dies from infections due to a lack of breastfeeding and the use of bottles, artificial milks and other risky products. In her powerful book, Gabrielle Palmer describes how big business uses subtle techniques to pressure parents to use alternatives to breastmilk. The infant feeding product companies’ thirst for profit systematically undermines mothers’ confidence in their ability to breastfeed their babies.”
- Diaper Free, by Ingrid Bauer. From the back cover: “Most new parents think of diapers as a smelly, expensive, and unavoidable necessity. The good news is that it’s possible—even practical—to raise your children with significantly fewer or even zero diapers. Diaper Free offers a gentle and nurturing philosophy that shows how”.
- Booklets published by the Association for Improvements in the Maternity Services (AIMS): www.aims.org.uk. Each booklet provides research-based advice on a specific topic, such as: induction, ultrasound, breech birth, and giving Vitamin K to newborn babies.
In England, the National Health Service (NHS) provides midwives who can offer advice to pregnant women, free of charge. However, one of our friends who recently had a baby found it frustrating that she did not have the same NHS midwife for the entire duration of her pregnancy, but rather saw a different midwife for each visit. Another friend had opted to pay a few thousand pounds for an independent midwife. Doing that meant she saw the same midwife for the entire duration of her pregnancy, and for four weeks postnatally, which meant she was able to build up a relationship of trust with her midwife.
Based on what Bianca read, and the midwife experiences of her friends, we decided to have an independent midwife, and we have no regrets about having done so. Our midwife, Kathryn Weymouth from Independent Midwives, is very knowledgeable, friendly, helps to reduce bureaucratic form filling to an palatable level, and was able to offer us wise advice during pregnancy. With the benefit of hindsight, we can see that she also offered life-saving advice during labour. Why did we take her life-saving advice? Because we had grown to trust her.
Bianca’s mother, Geta (short for Georgeta), came from Romania at the start of February to be with us during the final weeks of pregnancy, and is staying on for a while to help while Bianca recuperates.
A few weeks before giving birth, Bianca got violently ill with vomiting and diarrhoea. We rang our midwife for advice. When Bianca described the symptoms, Kathryn reassured her that: it was like just a stomach bug that was going round at the time; she would feel better within a few days; and the possibility of the bug bringing on an early labour was very low. Sure enough, Bianca recovered within a few days.
Then about two weeks later, Bianca started getting cold-like symptoms. Such symptoms are common at the start of a pregnancy—it seems to be the body’s way of forcing a woman who has just conceived to take things easy for a few days to give the implantation a better chance to succeed. Bianca had also learned that some women have similar symptoms in the lead up to labour—again, it seems to be the body’s way of encouraging a woman to get home and stay in bed in preparation for impending labour. Then a few days later, about 2pm on Wednesday 15 February, Bianca’s waters broke. Yippee! We were so excited. Ciaran let his manager know he was starting his paternity leave, and came straight home.
Some women go into labour just a few hours after their waters break. But in other women, it might take several days—or even more than a week in some cases—before labour starts. Our midwife had examined Bianca just an hour or so before the waters broke and knew that everything was fine. She told Bianca to telephone her when Bianca started having contractions, or whenever Bianca had any questions. Contractions did not start on Wednesday. We were not surprised, but we were a bit disappointed: we wanted to have the baby as soon as possible. Bianca’s cold-like symptoms did continue, however.
On Thursday, Bianca’s cold-like symptoms started getting much more intense. Sometimes, Bianca’s whole body aches when she has a bad cold, and this is what it started to feel like on Thursday evening. About 11:30pm on Thursday night, Bianca’s whole body was aching badly from the intense cold-like symptoms, plus she started to have contractions that were intensifying the pain. We called Kathryn, and she came over. Through examination, Kathryn discovered three things: (1) Bianca had a dangerously high temperature; (2) the baby’s heartbeat was dangerously high; and (3) Bianca’s cervix was dilated about 2 cm. Put simply, Bianca was in the early stages of labour (what doctors sometimes call pre-labour), but she had an infection (indicated by the high temperature and rapid heartbeat) that was a danger to both Bianca and the baby. Kathryn recommended that we abandon our plans to have a home birth, and instead go to hospital. She also explained that if the doctors could not bring the temperature and heart rate under control, then Bianca would probably need to have a caesarean section.
At a moment like this, it is vitally important to feel you can trust the advice of a midwife. If we had had a succession of NHS midwives, and a midwife we had seen for the first time that night was telling us to go to hospital, then we might have wanted to ignore the advice, perhaps thinking that the midwife was overreacting or prejudiced against home births. But we knew Kathryn well enough to know that she was completely in favour of home births, and Kathryn knew how much Bianca wanted a home birth. Because of this, we realised that Kathryn was not giving such unwelcome advice lightly. We agreed to her suggestion that she should call for an ambulance and inform the Royal Berkshire Hospital of Bianca’s condition.
Some people might think that giving birth at home is intrinsically dangerous: “What if something goes wrong? You might not receive appropriate medical attention quick enough to save your life.” Actually, midwives carry a medical kit with them, so they can deal with some of the problems that might arise. Also, if a problem arises that the midwife cannot deal with, then the chances are that there will be plenty of time to call for an ambulance. Bianca’s high temperature and the baby’s rapid heartbeat were dangerous if left untreated, but there was a time window of many hours in which they could be treated. So, it wasn’t like an episode of ER in which somebody with multiple gunshot wounds is brought into to hospital and the doctors instruct the nurses to hand them various instruments “stat”.
Five of us—Bianca, Ciaran, Kathryn, Geta, and one of Bianca’s friends, Stefanie, who Bianca wanted to attend the home birth—went to the hospital. However, the medical staff there said having so many people around would make it difficult for them to do their work, so Geta and Stefanie had to go home. Kathryn briefed the doctors and nurses on Bianca’s condition, and checks were done that confirmed Kathryn’s analysis. The doctors agreed that a caesarean section would be necessary. However, two things had to happen before the operation could start. First, blood samples from Bianca had to be analysed, which would take one or two hours. Second, an anaesthetist (anesthesiologist for American readers) would have to become available: the one on duty at the time was busy with another operation. Because of this, there was a wait of two hours before Bianca could have the caesarean. In the meantime, Bianca was put on a drip to get some antibiotics into her: these brought down her temperature and the baby’s heart rate slightly, but Bianca was in agony from the ache from her intense cold-like symptoms combined with contractions. She was given gas and air to ease the pain, but it didn’t work. The doctors did not want to give her any other pain relief because doing that might delay the start of the operation.
When it was finally time for the caesarean section, we were told that either Kathryn or Ciaran could accompany Bianca into the operating theatre. Ciaran decided that wanting to stay beside Bianca and to see the baby as soon as possible was less important than having Kathryn with Bianca to offer medical advice if the need arose.
In the operating theatre, Bianca was given an Epidural (basically, an injection into the spine) to make her feel numb. Then, a few minutes of surgery was sufficient to deliver the baby. Putting in stitches took considerably longer: about 45 minutes. During the operation, Bianca was awake but without pain. Nevertheless, she cried throughout, due to the sorrow that her plans for a natural birth were being replaced with the numb detachment of a caesarean section. Bianca was scared that this might prevent her being able to bond with her baby. During the stitching, the doctors placed Toby on Bianca’s chest for immediate skin-to-skin contact, which they hoped would provide comfort for both of them. Despite this, Bianca still cried. The doctors had to ask Bianca to stop crying because her body was shaking too much for them to put in stitches. Throughout the operation, Kathryn held Bianca’s hand and tried to distract her with positive conversation, such as an assurance that Bianca would be able to use a baby sling while recovering from the operation.
After the operation was complete, Bianca was brought back into the room where Ciaran had been waiting. The doctors were concerned that, having been born, Toby’s heart rate and breathing were still very rapid. But rather than put Toby into an intensive care unit, he was put onto Bianca’s breast. Bianca was still numb (it would be hours before the effects of the epidural would start to wear off), so she could not tell if Toby was feeding properly. But Kathryn and the other staff there ensured this was the case. After a hour, Toby’s heartbeat and breathing were slowing down to an acceptable rate—this is typical when a mother and newborn baby have skin-to-skin contact—so the doctors decided to continue this course of treatment. After a second hour, Toby’s vital signs were back to normal.
Because of Bianca’s infection, it was likely that Toby also had the same infection, even though his heartbeat and breathing rate had returned to normal. Because of this, the doctors recommended that both Bianca and Toby should start a five-day course of antibiotics: Bianca by tablets twice a day, and Toby by injections twice a day through a cannula. A blood sample was taken from Toby and sent for analysis, which would take two days. If the analysis indicated that he did not have an infection, then the course of antibiotics could be stopped. However, the results indicated that he did, indeed, have an infection, so he completed the five-day course.
Kathryn stayed with Bianca and Ciaran until sometime after 9am, so she could offer advice while decisions surrounding Toby’s treatment options were still up in the air. At lunchtime, Bianca and Toby were moved from the delivery unit to the maternity ward, where they stayed for the next five days, until their courses of antibiotics were finished and they were discharged. A blood test on Bianca indicated her iron levels had dropped low enough for doctors to consider giving her a blood transfusion. However, she was not showing any symptoms associated with low iron levels, so, instead of a blood transfusion, she was put on a three-day course of iron supplements delivered via a drip into a cannula.
Ciaran visited Bianca and Toby each day in the hospital. Unfortunately, Geta could visit only twice because she then came down with a cold which meant she then had to stay away from the hospital.
Bianca and Toby received excellent care from the medical staff at the hospital. In fact, it was quite intensive, with a nurse or midwife checking on them several times per hour. Having experienced the high skills of our independent midwife, Kathryn, we were delighted to discover that the NHS midwives were equally skilled. It seemed that some of the midwives either worked part-time or were being rotated from one ward to another, because Bianca might be treated by one midwife one day, and a different midwife the next day, and so on. At first, Bianca felt frustrated at this, because it made it difficult to build up a relationship of trust with the hospital’s midwives. However, Bianca grew to see a positive side to it: some midwives had an area of specialised skill, so Bianca could get advice on one topic from one midwife, and then get advice on a different topic from another midwife the next day, and so on.
During their stay at the hospital, Toby was breastfed exclusively, to the delight of the medical staff, and Bianca co-slept with Toby. The breastfeeding and co-sleeping was the highlight of the hospital stay for Bianca, and it helped her bond with Toby.
About 5pm on Wednesday 22 February, Bianca and Toby were discharged from the hospital. Bianca’s brother, Nick, who had just returned from a short holiday in Romania, collected us from the hospital in his car and drove us home. In the few days since then, we have been adjusting to the household changes.
Bianca had dreamed for many years of having children, and of giving birth naturally. She had done everything right to ensure the birth of a healthy baby: she didn’t drink or smoke, she ate a very healthy diet, lead an active lifestyle, and read many books on relevant topics, such as fertility, pregnancy, childbirth, breastfeeding, co-sleeping, and attachment parenting. Because of this, she felt devastated when an unpredictable infection resulted in her having a caesarean section. Just before Bianca was taken to have her operation, Ciaran was shocked to hear Bianca say, “I’m sorry”. In fact, he was so shocked that he could not respond. He realised that, quite irrationally, Bianca felt guilty and ashamed for not having a natural childbirth.
After the operation, Bianca repeated the “I’m sorry” statement. Ciaran assured her that she had done nothing wrong and had nothing to apologise for. We both worried that such irrational feelings of shame might result in postnatal depression. However, over the next few days, Bianca came to appreciate that the caesarean section had saved both her life and Toby’s. Before the operation, a doctor had explained that, because this was Bianca’s first pregnancy, labour might go on for up to, say, 16 hours, and it was likely that neither she nor her baby had the strength to endure such a prolonged labour with the infection that was causing them both intense distress. Rather than feeling ashamed for not having a natural childbirth, Bianca should feel grateful for the life-saving operation.
Bianca and Ciaran are both optimists by nature, and are good at finding the silver lining in clouds. It was natural for Bianca to feel frustrated and cheated at not having a natural childbirth, but the day after the operation—when the numbing effects of the epidural had worn off and, with the aid of painkillers, Bianca was able to get out of bed to change Toby’s nappy—she was starting to see the positives in the situation. She was alive and recuperating, and she had an adorable, healthy baby. The breastfeeding and co-sleeping helped Bianca to regain her positive attitude, and that, in turn, helped to speed recovery.
Please do not feel obliged to buy any gifts for us or Toby. We say this for a few reasons:
- We are in a comfortable financial situation—we own a house without a mortgage, and Ciaran has a well-paying job—so we can afford to buy whatever Toby might need.
A few years ago we saw the excellent online documentary
The Story Of
book of the same name is also great). That video has encouraged
us to reduce our materialistic ways, and we have been gradually
incorporating the Reduce, Reuse, Recycle concept into our
lives. As such, we want to avoid receiving an over-abundance of
materialistic gifts for Toby.
The Story of Stuff also made us aware that many synthetic materials commonly used in children’s toys contain toxins that may not have an adverse effect immediately, but can have a longer-term impact on health. This has strengthened our desire to reduce our materialistic ways, and, whenever possible, to opt for toys made out of wood and rubber rather than plastic.
- During pregnancy, Bianca visited charity shops to get pre-loved clothes for a newborn baby and children’s books. Because of this, we have sufficient baby clothes to last us for a few months. If you happen to have some pre-loved clothes for a six-months-or-older baby that you would like to pass on, then we will gratefully receive them, but please do not send us new clothes.
There is, however, one sort of gift that we would love to receive, as we now explain…
We believe there are two kinds of power: (1) power over people; and (2) power to help people.2
It is easy to think of examples of the first kind of power, and mainstream society encourages people to seek out that kind of power. Of course, power over people is a scarce resource and it has a tendency to corrupt: hence the slogan, “Power corrupts. Absolute power corrupts absolutely”.
In contrast, the second kind of power—to help people—is in abundant supply: almost every individual in the world has the power to help others, often in small ways, and occasionally in bigger ways. Unfortunately, the power to help people is often overlooked. This is a great shame, because some of the most inspiring people in history have been those who have used their power to help others to great effect: for example, Florence Nightingale, Gandhi and Martin Luther King Jr.
We want Toby to grow up knowing that, regardless of how rich or poor he is, he has the power to help others, and for him to use that power. Towards that goal, we would be delighted if you could spare the time to write Toby a letter in which you briefly explain how you use your power to help other people. An example letter is shown in Figure A.3.
I am a friend of your parents. I contribute towards making the world a better place in the following ways.
First, I have insulated my home and use energy efficient light bulbs. These reduce my energy consumption, which is important because of climate change.
Second, I buy a copy of The Big Issue each week. I enjoy reading the magazine, and the homeless people I buy it from make a profit from it, which helps them to rise out of poverty.
There is no minimum or maximum size to the letter: it might be as short as one paragraph or longer than 50 pages. You might want to say that you donate money to a good cause, or that you do some volunteer work in your local community. If you have a career that enables you to help people (or animals, or the environment), then you might discuss that. If you do any sort of activism aimed at making the world a better place, then please mention that.
Our aim is to compile these letters into a book. Then, when Toby grows a bit older, we can read him not just fairy tales but also real stories of how ordinary people—such as relatives, friends and random visitors to this web page—have the power to help others and make the world a better place. In this way, with your help, we can inspire Toby to make a positive contribution to the world.
Ciaran has written software that will make it easy to create an anthology of the letters and, by default, he will make the anthology freely available online (in HTML format for online viewing and PDF format for downloading) in the hope that others might find the letters inspiring. If there is demand for a printed version of the book, then he might investigate the possibility of making the book available through a print-on-demand company.
If you do not want your letter to be included in a publicly-accessible anthology, then we will be happy to print out the letter separately for Toby to read.
Doctors have told Bianca it will take about six weeks for her to recover from the operation and, until then, she shouldn’t lift anything heavier than Toby. During this recovery period, Bianca and Toby will be spending most of their time at home, and letting Geta take care of housework. Visitors are welcome and encouraged. No advance booking is required.
Ciaran and Bianca McHale
- We are aware that co-sleeping is controversial because of anecdotes of a sleeping parent rolling over and smothering their baby. However, research suggests that this danger exists only if the parents smoke, are drunk or high on drugs. We don’t smoke, drink alcohol or take drugs. The following newspaper article summarises research findings: www.guardian.co.uk/lifeandstyle/2009/oct/16/sudden-infant-death-syndrome-children.
- A more in-depth discussion of the two kinds of power is given in Chapter 2 of the slides manual for the Skills You Need to Change the World training course, which is available at www.ciaranmchale.com/training-courses.html#training-skills