I spent the New Year in Norwich with family, after Christmas in Barcelona. Ethan (shown here underwater in all his glory) will turn 1 year old in 5 months and he is the focus of my new year's reflection.
Ethan was born at home in a birthing pool after a reasonably rapid overnight labour. I had the pleasure of lifting him out of the water for his first breath and, of course, cut the umbilical cord. The midwife recorded his time of birth at 5:22am, at the very moment when dawn broke in Liverpool that day. Everything went very well throughout the delivery; the midwife even said it was the d the best she had ever attended in her 15 year career.
Beatriz was in such a good place physically and mentally by that day; relaxed, in control and doing it the way she wanted. The pool was phenomenal - an incredibly rigid inflatable structure, providing crucial support, lots of space, and soft cushioning. It was also the only pain relief she required, except for 2 paracetamol which she took only because the midwife suggested it. Needless to say, Beatriz is now a massive advocate of both having a water birth and home birth, though we are conscious of the fact that we live just 200 metres from the hospital and this influenced our perception of risk.
Yet, the risks associated with home birth are really poorly articulated in the UK. Just this week, the Head of the Royal College of Midwives commented on the slight decrease in homebirths from 2009 to 2010, explaining that this is an indication of the deep seated medicalized view of birth that exists within the UK. Medicalization is a subject I've given considerable thought. The UK is not exceptional in this regard, though its home birth rates are well below many other countries.
Our own experience of the NHS in this regard was probably about average. The Liverpool Women's Hospital had recently appointed a Senior Midwife Consultant to improve the home birth rates around Merseyside and we had a conversation with him, after trying to find out whether they could undertake cord blood harvesting at the delivery. The umbilical cord is rich with stem cells, which can be used to protect the child against blood related disorders, such as leukemia. It may even be used by other members of the family, such as a future sibling with a health problem. For this reason, the incentive to store cord blood is strong, especially considering that the cost is perhaps only as much as a family holiday.
In any case, saving cord blood was something I had thought about a great deal and have often spoken about in lectures about the ethics of stem cell research. I often introduce the subject by describing a real life experience I had walking into Borders books in Glasgow and seeing a magazine on one of the shelves with the front page headline: 'Have you saved your baby's stem cells?' These moments when technology becomes a moral imposition for everyday people are often the focus of my work. Beatriz and I wanted to save them and were even willing to pay the £2,000 to undertake the procedure and storage - but found that there were various obstacles to our achieving this.
First, while the procedure of harvesting is reasonably simple, the Human Tissue Authority - along with the blood storage facilities where the blood would be located - requires that a licensed person undertakes the procedure.
Second, the NHS is unable to support the process; its midwives are neither trained nor licensed to undertake the procedure. While a couple of the midwives we spoke to during the pregnancy said it would be fine, when we investigated further to obtain an official confirmation, it became quickly apparent that the NHS could not provide this facility at all, whether or not we were having Ethan in a hospital or at home. As such, the only route would have been to have contracted a licensed person who we would most likely have to pay to come to Liverpool and stay the night or so that would be necessary in order for them to be available to collect the blood at the opportune moment.
The implications of this for a home birth are particularly problematic, as one of the main reasons for having a homebirth is to avoid the need for other people to be around. So, the idea of having someone hanging around our living room while Beatriz was in labour, did not really appeal. Of course, we would also be paying that person an hourly fee of some significance, while they were waiting.
Third, we discovered that the collection of cord blood is actually not completely compatible with a natural delivery. Specifically, once the delivery has occurred, there is a moment when the blood from the cord passes into the baby and it is generally thought to be a good thing., Collecting cord blood would involve cutting the cord before the final amount of blood has passed through it into the baby. Thus, cutting and storing would deny the baby this amount of blood. It is unclear to me whether this implies a significant health risk, though some evidence does say that this could significantly increase health risks for the new born child. One NHS website indicates that it ought not interfere with anything that would imply a risk, but this level of detail certainly did not translate to our situation in Liverpool, where it felt we may have been the first at our hospital to have inquired into this. Moreover, it is difficult to decide how one compares this risk with the risk of the child contracting an illness that may require cord blood. However, the more certain health risk of the child being deprived of necessary blood seemed more significant to us.
In the end, this totality of obstacles led us to decide that collecting cord blood would not be desirable. One other matter I have not yet mentioned was the NHS claim that the distraction of collecting cord blood could interfere with the delivery itself and this may be an additional risk.
All of this debate was significant for us, but it is light years away from what I had intended to write about on this new year's day. Other things I wanted to mention were the mobile phone apps we'd used during the pregnancy, delivery and first months of Ethan's life. They helped a great deal just to keep track of his development. The most useful were a contraction timer and an app that allowed you to monitor sleep, nappy changes, and feeds. Each were very helpful and we're now using a growth chart app. We also bought a Lindam video monitor, which has been an amazing way to provide a sense of freedom, togetherness and an opportunity to learn his patterns without having to run upstairs every time he cries. Its musical function has also worked numerous times to settle him when else we might have been tempted to use a passifier.
Ethan has done very well from the start. We followed the Gina Ford routines quite carefully, especially in the first 6 months. He has never slept a full night with us and has been happy in his own room from day 2. From the end of the first month, he was even sleeping through the night - and not just the 5 hours that is the official definition of sleeping through the night - but from 7pm to 7am. As such, we've had nearly no sleepless nights and he's always eaten very well.
Fortunately, we've not yet had reason to regret our decision to protect the moment of delivery, in exchange for not guarding against a potential health problem Ethan may encounter and hopefully, we will not have any future cause to regret it. However, I cannot help but feel that this simple practice needs some radical rethinking both within the NHS and generally. There is nothing more frustrating than when a present-day technology fails to improve society, either because of unreasonable costs or incapable systems and presently, it seems that cord blood collection structures fail most people. Indeed, a considerable public resource is lost by the inadequacy of these services and this may be the biggest lossl.