Preventing Prematurity and Banishing Blame

Sunday was World Prematurity Day. It was the second since Boo was born, but the first since I have been blogging and the first one that I felt I could get involved in in my own small way. I wrote a blog post in which I tried to sum up what prematurity has meant for my family and (around Sissyboo’s 6th birthday party) tweeted, chatted online and read blog posts by others for around 16 hours. It was emotional and exhilarating, two words I didn’t really know the meaning of until having a premature baby of my own. The premature baby community – a global one – fought back against the challenges our children and families have had to face with eloquence, compassion and fierce tenacity. We learn those things from our children.

The focus of my tweets and posts last week was all about what comes after pre-term birth rather than before. Because, frankly, in my experience, once you’ve had a baby born too soon pregnancy fades into obscurity. Except that is, in those vivid moments at 3.06 in the morning when they flood back. When you torment yourself by thinking did I do this? Did I do something wrong? Is it my fault my son was born at 29 weeks? Is it my fault he has cerebral palsy? Will he grow up hating me if he can never walk? I’ll come back to those moments shortly, just as my brain does, with cruel predictability on a weekly basis.

Given how resolutely I try to focus on life after prematurity on the blog, I was especially grateful to be invited for a World Prematurity Day event hosted by Tommy’s and Bounty at the House of Commons yesterday which was devoted to pregnancy health. To be honest, I wasn’t sure what to expect. This is the first time that I have been invited to anything on the back of my blog. I was flattered, interested and nervous in pretty much equal measure. And then I was delighted to learn that two of the wonderful women who work for First Touch, a neonatal unit support group at St George’s in London would be there and that Jennie from Edspire, whom I’d never met, but who has been one of several bloggers who have led me by the metaphorical hand through the last 19 months would be speaking. I have a lot to learn about prematurity still and was eager to find out more to enable me to do as much as I can to help others.

The focus of the event was on prematurity prevention. In particular, Tommy’s was promoting their Five Point Pregnancy Plan, which was launched two years ago and which is disseminated via Bounty to their staggering 2.5 million members. You can read more about the plan and Tommy’s work in identifying and helping vulnerable women here. But the main areas of focus are as follows: smoking cessation, eating a nutritionally adequate diet, exercising, tackling obesity and addressing mental health issues.

This is not, as you’ll notice, a prematurity-specific plan. It’s about promoting healthy pregnancy for all women, whatever the outcome. It may sound like old-fashioned common sense, but this is vital information that needs to get out there. As Jane Brewin from Tommy’s noted in her speech, it is shocking to think that there are women in this country today who are struggling or otherwise unable to achieve a nutritionally balanced diet for themselves and their unborn children, but it’s no less true for that.

The importance of giving women the right information so that they can make appropriate ‘lifestyle choices’ – the buzzword of the night – was made passionately and everyone in the room was, I’m sure, in agreement that empowering as many women  as possible in pregnancy to make healthy choices for themselves and their children is an incredibly important initiative of which Bounty and Tommy’s are justly proud.

So why did I feel so uncomfortable? Why did I have tears rising to my eyes? (I’m not a crier, by the way. It takes a lot to make me cry.) I have to answer that question in two parts, I think. The two parts of Mrboosmum need to speak.

First, there’s professional me. For reasons you don’t need to worry about, I have spent quite a lot of time reading pregnancy and midwifery manuals from the seventeenth century onwards. (I know, I’m an odd individual. Truly.) Obviously, what was known about pregnancy and labour, let alone prematurity (a term that wasn’t even around at the time), was very different then when compared to what we know now. But there is a striking continuity of advice offered to pregnant women over the past 300 years. In the eighteenth century there’s a lot of advice about not playing cards too much (exciting the brain was supposed to lead to still birth or ‘birth defects’) and eating lots of chocolate and sitting on the sofa is very much frowned upon. The advice is: exercise, but not too much; eat, but not too much etc. Sound familiar? (I could go on, but you get my drift…)

There is a good reason why things have changed so little. This is sound, sensible and now medically-verified advice that women should be heeding. But tone is important, I think. The phrase ‘lifestyle choices’ makes me bristle. In the eighteenth century the term was ‘female employments’, but it means the same thing. Women are unreflectively doing the wrong things and making the wrong choices about how to pass their time through pregnancy.

The rhetoric of choice is a difficult one for me. I have never smoked. I know many women who have who have chosen not to smoke in pregnancy. I have known people take up gym memberships or opt to go on diets before trying to conceive. But is this really all about choice? For some women, eating healthily is more an act of will than a matter of preference, as Jane Brewin implicitly suggested yesterday. Diet is, of course, affected by various socioeconomic factors. They need to be targeted as much as women do. And mental health? Well, where’s the choice there except that stigmas need to be removed if women are to feel able to accept help it if and where it can be accessed. If I could have written ‘if’ in capital letters and not look like I was shouting, I would have.

Let me be clear: making informed choices available to all pregnant women is important. And I am glad that Bounty and Tommy’s are doing this work. But choice also implies responsibility and with responsibility comes blame. So let the other me speak. The Mom me, rather than the professional me (although, to be honest, we are the same person.)

Mom me will never forgive myself for Boo’s premature birth. I have tried. I wrote a blog post about it and re-read it regularly. I spent 6 weeks doing cognitive behavioural therapy. But I will never forgive myself. I know that.

Did I make the wrong choices?

No. I was not over 40 when Boo was born (one lifestyle ‘choice’ and proven risk factor mentioned in the  presentation but not part of the Plan). I took folic acid and pregnancy vitamins for months before I tried to conceive. I have never smoked and didn’t drink. I am a vegetarian of 25 years and eat healthily and well. My BMI was normal. I exercised gently but regularly, so much so that weeks after giving birth to Boo and breastfeeding I started training for a half marathon to fundraise for premature babies. I have my own mental health issues, but didn’t in pregnancy. I have prematurity to thank for them.

On paper, at least, I look like a paragon of pregnancy virtue. A ‘good girl’, in eighteenth-century terms who in twenty-first-century parlance made all the right choices.

But my son was born at 29 weeks in a spontaneous labour. I had had one healthy term baby before that. This shouldn’t have happened to me. To him. But it did.

And I am not alone. I am one of the around 40 per cent of women who gives birth prematurely with no known cause. And I am grateful that Tommy’s funds research into prematurity because I hope that in the future they may be able to lower that shocking statistic (although us forty per cent weren’t mentioned yesterday at all).

Important though the 5 Point Plan is, I was already following its advice and it didn’t help us. Neither did it help Jennie, nor my colleagues from First Touch. All of us read the books. It made no difference in our cases.

And so the tears rose up in the presentations. Because this rhetoric of ‘choice’ can feel to mothers like me who made the right ones like a rhetoric of blame. I know rationally that I have no reason to feel guilty. The last time I shed real tears, lots of them, was just a few weeks ago when Boo’s cerebral palsy diagnosis was confirmed. I wasn’t crying because he has CP. I’d known that for many months before the piece of paper arrived. I didn’t cry when I saw the words ‘severe brain damage’ because I saw that damage for myself on CT scans in May of last year. The images are etched into my retina.

No: I cried because the MRI scan confirmed that it wasn’t my fault. Boo’s brain injury was not sustained in pregnancy. Nor on the day he was born. I didn’t do it to him. He got an infection. In the neonatal unit. It caused the massive brain bleed. Not me.

But I will feel guilt until the day I die, even though I know this is not my fault. Jennie, at several points in her wonderful speech about Esther and William yesterday, talked about her ‘failure’ to take her children to term. I nodded through the tears (this time tears of solidarity), because I share that sense of failure. I feel it daily even though my head knows I shouldn’t.

Information is vital. I work in education and am passionate about it. I believe in women having choices in all aspects of their lives and access to all of the resources they need to make the best decisions for themselves and their families. And I am grateful to the work of Bounty and Tommy’s.

But what I feel most passionate about today is doing more. More to raise awareness about prematurity and its many known and unknown causes. More to support other women who are about to or have already experienced premature birth. More to help them live with prematurity and whatever that brings, whether its beautiful, healthy children like Esther and William, or gorgeous babies like my Boo, who will never outgrow prematurity and will live with cerebral palsy and epilepsy for the rest of his life.

I will not stop, because prematurity is not just a pregnancy issue, or something that ends with your stay in the NICU. It stays with you and your children forever.

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12 thoughts on “Preventing Prematurity and Banishing Blame

  1. jennie

    This is a very powerful piece of writing and will be very similar to what I write from my view point in the room last night. I did feel like people were looking at me and wondering what did I do to make my children come so early. i was in fact unlucky, i got sick and only because of wonderful surgeons and medical teams are any of us alive today. I am another that followed all the rules but still could not carry my babies to term. I was honoured to meet you yesterday and I hope that we will be able to work together in the future to ensure people know that prematurity is permanent, you do not grow out if, it does not go away. Prematurity does not go away x

    Reply
  2. itssmallsworld

    This is, as ever, a great post. If I may, I think this issue goes wider than prematurity – women are given to believe that if they do x, y and z this will equal a perfect baby and many of us know that, for whatever reason, having done everything we should, it still didn’t happen. It was through my involvement with swan and your ‘letter to me’ that I began to realise Small wasn’t my fault – to really accept it. More time also needs to be devoted to all these women to stop them falling apart. I’ll stop now 🙂 x

    Reply
  3. Amy

    I can’t agree more when you say prematurity is not just a pregnancy issue, and more is it confined to the neonatal period. I probably made a few slip ups during pregnancy but nothing gigantic. Our NICU ride wasn’t smooth yet wasn’t as hellish as some and yet 3years on the problems of prematurity loom in our life and we can try and make them as best as possible for my daughter but not make hem go away. I hope in time they get better but there are no promises. I am increasingly frustrated on the lack of information regarding long term prematurity once the first two or so years or over. Do they assume we either fall into now “normal” or special needs camps for someone else to provide information? These last few weeks in hospital for us at age 3 have made me feel very alone save within the preemie community. I am very glad there are blogs and moms speaking out x

    Reply
    1. mrboosmum Post author

      Amy, I am really behind on replying to blog comments, and was going to sit down and respond to people’s lovely remarks later in the week, but I can’t let this one go without a quick reply in lieu of the more detailed one to want to send. But for now, I just want you to know I agree with everything you say. And more to the point, I hope Wriggles is OK. Ever since hearing you were back in hospital, I’ve been thinking about you both, wishing I could do something to help.

      You are not alone, Amy. You (and your blog, and your lovely words of advice on the Bliss message board before I started the blog) have helped me so much in the last 19 months even though we have never met. Thank you. Lots of love to you and your lovely girl. x

      Reply
  4. singlemotherahoy

    I completely agree. My daughter was “only” 5 weeks early, and we were extremely lucky that she was a healthy weight and had no major problems.
    Throughout my pregnancy I followed the advice to the letter. People laughed at me for being too cautious, refusing to eat certain foods, to have even a sip of wine at Christmas. I know now that if I had done any of those things – even a single sip of wine – then the moment I went into labour I would have thought back to that point and said “if only…”
    As it was, I felt blamed for my premature labour any way – by my then partner who told me it was my fault, and then went on to tell others that I deliberately had my daughter early because I had a cold and wanted to be able to take medication for it.
    I never knew the figure was that high – 40% is massive. We should know more about it. And there should be less blame to be placed. People want there to have been a reason. I know I wanted there to be a reason and was accepting of it myself because I couldn’t see what else it could have been.

    Reply
  5. mummytries

    What an incredibly moving post. You sound like a truly amazing lady, and wonderful mum. I’m sure in the years to come your children will also see how amazing you are.

    There will always be guilt attached to parenting and all mothers have to deal with it the best they can #PoCoLo

    Reply
  6. sarahhillwheelers

    Quite teary after reading your powerful post. Boy wasn’t premature, but spent a month in hospital after birth where we received diagnosis. For me, sense of guilt has got less (though I know it is irrational and resurfaces), guess, like prematurity, it is something you continue to live with (I have compared it to a scar that dies back, but still itches….I am not 8 years on).

    Your thoughts on lifestyle choices are interesting, and powerful. I agree there is a connection there between “choice” and blame, and am not sure that is healthy…perhaps it is just so hard to accept that things happen for “reasons” we don’t know yet, or which may be totally random. And I sometimes think this is “comforting” in some way for some people (usually who aren’t confronting the enormity of something in their lives, like a life limiting condition, that there is little control over). Or perhaps it’s just the difference between speaking “from the head” and “from the heart”.

    Sorry. I am rambling, just wanted to say, I think I get where you are coming from. (I think I have blanked out some of my early conversations with the health visitor). And you sound like an amazingly strong person to do what you do at, which I suspect, can be at times all the harder because it is so close to your heart (it took me years after J’s birth to even go on a forum).

    #PoLoCo

    Reply
  7. Sara (@mumturnedmom)

    This is a very moving, powerful and informed/informing piece of writing. I am eternally thankful that I can’t begin to imagine what it must be like, but I still worry every day about something happening to my children that is out with my control,but that I would forever blame myself for – just because I wasn’t in control for that moment. I hope that you, and others, can continue to provide all of us with insight and support xx #PoCoLo

    Reply
  8. Victoria Welton (@VicWelton)

    A really, really moving post from you. You always write straight from the heart and I enjoy reading your posts. As hard as life is for you, I think it is so important that you document it. This must be a massive support for others in your position. Thanks for linking to PoCoLo x

    Reply
  9. judithkingston

    I hope you manage to raise awareness everywhere you go. Here in the first world we have come to feel, it seems, that life is what you make of it, and if things go wrong it must be your own fault somehow, somewhere. Sometimes, terrible things happen and they are out of our control. We know this with our minds, but I can see that if I were in your situation I would also feel like it was my own fault despite all evidence to the contrary. When it comes to our kids, we always feel like, as mothers, we should be able to shield nad protect them from everything. Thank you for this wonderfully well-written, well-argued and stirring post. I will try and be more aware and more supportive to friends with premature babies. xx

    Reply
    1. mrboosmum Post author

      Thank you for your lovely and thoughtful comment. I read it the day you posted it, but things have been unusually hectic since. (Boo has been ill.) But I wanted to reply all the same to say thanks.

      Reply

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