Book Reviews

Book review – The Book You Wish Your Parents Had Read… by Philippa Perry

This beautifully kind, wise and compassionate book has been a wonderful reminder of the parent I aspire to become. It goes without saying, of course, that I am not a perfect parent. Who is? The joy of this book is that it does not set out to achieve perfection (which would only set you up for failure), nor does it reprimand you for mistakes made in the past. It gently encourages you to explore your words, actions and the examples you set to your child, observing how they might affect your child(ren), how they affected you when you were a child and the possible long term effects on your relationship with your child.

It’s not about how many times you mess up, lose your rag and end up crying in a corner (with at least one child screaming on the floor at the same time). It’s about accepting that these things happen, putting actions in to place to minimise them (ie recognising your own limits and how to manage them), and ‘repairing the rupture’ by being compassionate with yourself and authentic in your restorative actions.

It has great examples and case studies of where parents have struggled with their child(ren), even to the point of wanting to leave the family unit, and offers tender, considerate and often humorous responses to the challenges we all face in our parenting (and indeed all) relationships in our lives.

It ties in perfectly with the La Leche League philosophy of ‘loving guidance’, which is one of the many reasons I kept going back to La Leche League. I knew I wanted to follow the gentle parenting path, I think even before I became pregnant, and it was demonstrated so admirably by the mums present at the meetings.

It reminded me that loving guidance is a long term investment (it also has short term benefits too), that patience is a virtue (no one has taught me more about being patient than my son), and that if you’re not looking back at your life and cringing at certain moments, you’re not learning and growing as a person, parent and human being.

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Investigating the effect of reflexology on the breast milk volume of preterm infants’ mothers

A critical review of Mohammadpour A, Valiani M, Sadeghnia A, Talakoub S. Investigating the effect of reflexology on the breast milk volume of preterm infants’ mothers. Iranian J Nursing Midwifery Res 2018;23:371-5.

Mohammadpour et al (2018) conducted a clinical trial on the effects of reflexology on the breast milk volume of mothers of preterm infants. The clinical trial aimed to provide new evidence for the effectiveness of reflexology on breast milk volume and further explore the relationship between lactation and reflexology.  The trial indicates that reflexology is effective in increasing breast milk volume on mothers of preterm infants. However there are several factors that need to be considered when interpreting the results. 

There is no mention in the selection criteria of the mothers of the frequency of breastmilk removal (1) and the effect of preterm delivery on mammogenesis (2) as these are known factors for affecting breast milk volume. As the article itself states, “…the mechanism of milk production is complex, detailed research is required on the relationship between lactation and reflexology”. 

The study shows that statistically, reflexology treatment increased breast milk volume for the first four days of the intervention. It is a low cost intervention with no specialist equipment required but does require a commitment of time from both the mother and the person giving the treatment and training of personnel to administer it. 

The trial contributes to a small but significant group of research on the effects of reflexology on labour, delivery and lactation (11) (12) (5).  It adds to the body of knowledge in this emerging field of reflexology research and shows us how much more there is to discover when there is enough data to generate systematic reviews and meta-analysis. Only then can conclusive arguments be made. 

The points stimulated during the treatment given were those generally accepted to affect the areas of the breasts (between the metacarpals of the toes) and the pituitary gland reflex (on the pad of the big toe).  The pituitary reflex point is included as the point at which the oxytocin hormone originates (9), Oxytocin causes the ‘let down’ reflex of the milk, pushing milk out of the breast when the breast is stimulated by suckling from a baby or the suction of a breast pump. 

All the mothers who participated in the trial had delivered their baby via Caesarian section, which is known to delay the onset of lactogenesis II (10). This puts all the mothers on a level playing field, as mixed delivery methods can not be compared. It is unfortunate that the trial couldn’t have been completed exclusively on mothers who had delivered vaginally, as this is the norm.  As the article states “…the impossibility of selecting participants who had had a natural delivery was another limitation of this study”. 

I question the ethics of separating the mothers into just the two groups of intervention and control. Would the psychological effects of participating in a study but not knowingly getting the intervention (ie foot massage) have an effect on lactation?  Could it be the time taken to receive the intervention, allowing the mothers to sit and relax at an undoubtedly stressful period of their lives have more of an effect than the reflexology itself? We already know that reflexology has been shown to reduce levels of anxiety (3)(4) by reducing stress hormone (adrenaline and noradrenaline) levels and increasing endorphins and oxytocin (5), which has a direct effect on lactation (6). Might it have been a better methodology to separate them into a reflexology group, a general foot massage group and a control group? This may then definitively prove that it is the specific reflex points that are responsible for the increase in breast milk volume. It is unclear what the researchers are trying to prove with their methodology. 

The frequency of milk removal from the breast is one of the greatest contributing factors to output volume (7), and timing of early breast milk expression too (8). These factors were not apparent in the selection of the mothers for the trial and their non-compliance in the researcher’s request to not use other interventions to increase milk supply can not be ruled out. Prolactin, the hormone responsible for breast milk production, increases throughout pregnancy, and premature deliveries between 22 to 34 weeks gestation may cause mammogenesis to be incomplete for full lactation (2). Again, this has not been taken into account in this study and will have an impact on the milk volume output, and as the mothers selected are between 29 – 36 weeks gestation, conclusions are hard to draw. 

It is a very small scale study and although the statistics drawn from it clearly show there is an increase in breast milk volume in the reflexology intervention group, there are too few participants to say with complete confidence that reflexology has an effect. Further trials must be undertaken, with more precise selection criteria and larger samples to improve our understanding of the reflex points and their effect on breast milk volume. This is an emerging field and this trial shows how much more we have to learn about reflexology and it’s potential benefits.  It has shown some interesting and exciting insights into the relationship between reflexology and breast milk volume and I look forward to more research being carried out and published. The stronger the evidence base, the stronger the arguments will be to include reflexology treatment in the care of mothers and their infants during pregnancy, child birth, breastfeeding and beyond. 

References 

(1) Infant demand and milk supply. Part 1: Infant demand and milk production in lactating women.

Daly SEHartmann PE. 1995.

(2) Complicating influences upon the initiation of lactation following premature birth Cregan, M. D. et al (2007).

(3)Effect of foot reflexology on anxiety of patients undergoing coronary angiography Mahmoudirad et al 2013

(4)The Effect of Foot Reflexology on Anxiety, Pain, and Outcomes

of the Labor in Primigravida Women. Hanjani et al 2013

(5) A concept analysis: the effect of reflexology on homeostasis to establish and maintain lactation. Tipping et al 2000

(6) The Womanly Art of Breastfeeding, La Leche League International, 8th edition, Pinter & Martin. 

(7) Breastfeeding and Human Lactation, Riordan & Wambach, 4th edition, Jones & Bartlett

(8) Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study.

Parker LA1, Sullivan SKrueger CKelechi TMueller M.

(9) Reflexology in Pregnancy and Childbirth, Tiran, 1st edition, Churchill Livingston. 

(10) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Dewey KG1, Nommsen-Rivers LAHeinig MJCohen RJ. 2003.

(11) The Effect of Reflexology on Pain Intensity and Duration of Labor on Primiparas.  Dolatian et 2011

(12) Reviewing the effect of reflexology on the pain and certain features and outcomes of the labor on the primiparous women Mahboubeh et al, 2010

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Gardening for the soul

Ommmmmmm

I’ve never thought of gardening as a spiritual practice before, but spending time in my garden today has inspired me to reflect on the processes involved and how they intertwine with what it means to me to grow, both spiritually and practically. 

It’s not about being perfect. 

My garden is not perfect. It never will be. I yearn for a lawn big enough to have a trampoline on, and enough space to host my friends, as we while away a lazy afternoon, eating, drinking and laughing together in the sun. But when I think to times when I’ve had large gardens (up to 1/2 an acre when living in Alderwasley), I think how overwhelming it was, how it was a constant pressure just to mow the lawn, let alone keep on top of the weeding, pruning and actually growing the things I wanted to grow.  My present garden is tiny yet manageable for me, a little bit of time spent in it makes a big impact and it means I have time to lie back, relax and enjoy it (sunbathing is one of my favourite activities, and right now I’m multitasking by writing this whilst laid-out topping up my vitamin D). 

Tiny, lots of work to be done, loving it.

Currently my garden sports a large collection of pallets, that suit my budget (ie free) but not my aesthetic. They are ugly (too square, too utilitarian, too cheap!), but useful and have been repurposed as strawberry planters, a vegetable bed and sun bathing deck. One day I shall have raised borders, with proper garden furniture and a new fence that I can safely grow things up. I’m enjoying the process, however, of getting creative with zero budget (I have wonderful friends and family who donate seedlings and cuttings to help my garden grow and develop) so that I can save money for the big stuff. 

Plants aren’t perfect either. No one says “oh that birch tree is gangly”, or “that lilac smells too much, turn it down a notch” (see Hollie McNish’s poem ‘If flowers had disposable income’), and yet my garden is full of beauty, and scent, and texture, and things that bring me pleasure every day. 

The work is constant

If only you could weed once and that would be it. Not even an annual event. Just the once and no more weeds, ever. But much like the negative thoughts that are a seemingly constant, internal companion, when weeds are accepted as part of the deal with life, are confronted often and early, literally nipped in the bud, they are far easier to contend with and maintain than when left to run rampant and unchecked. Don’t let them become monsters!

Toes as tools for weeding

Gratitude 

My garden also reminds me to celebrate the little things, like the promise of my strawberry plants getting flowers on them, pea shoots sprouting to the sky and the return of the stunningly deep red/brown/burgundy/purple (it changes daily) leaves on the copper beech tree on the opposite side of the road. I’m grateful I have a space I can do yoga in, dry my washing (what’s better than snuggling down into bed sheets that smell of outside?) dine alfresco on food that I’ve planted, watered, nurtured and harvested, and have water fights in with my son.

Home-grown lunch

I could go on. I’m practicing the art of not being attached to outcomes, and my garden is a great proponent of this, but I think that’s a separate article, that I may or may not get round to writing. And I had to come in inside because I’d had enough time sunning my back (I didn’t realise how long this would take to explore/write when I first got started), and I can’t sun my front whilst writing this. So I’m off back outside to sunbathe a wee while longer, dig up a bit more earth, get mucky and grow things, myself included.