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H Y P H E N E T T E . C O M

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Too posh to push or just plain terrified? A 2017 study found 14 percent of women suffer from tokophobia with the number rising steadily from 2000. This could well be attributed to the proliferation of the internet and storytelling online as academics warn that parenting forums are contributing to a rising fear of childbirth. Really though?

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The fascination with royal babies

Little whips the media into a greater frenzy than a royal baby. But amid the pomp and circumstance, there’s

something archaic and strange about declaring any baby’s arrival newsworthy. In this day and age, when the royal family is more symbolic than anything, why are we still obsessed with royal babies?

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The reality of preterm birth

No first time mother-to-be expects to find herself in the delivery suite at the end of week 25 of her pregnancy but in October 2006, Mandy Daly found herself

in the unfortunate situation of being one of those ladies who contribute towards the 4500 babies born too early in Ireland each year.

06 First things first

56 Why I don’t want kids

44 All in a day’s play

58 Digital contraception is coming

48 Motherhood behind the lens

62 Women of a certain age

50 Labour’s snow joke

66 Looking after your gynaecological health

54 Where’s the male pill?

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hy are we talking about pregnancies, uteruses and childbirth? To quote Michelle Obama, 'I think it’s the worst thing that we do to each other as women, not share the truth about our bodies and how they work'. Obama was referring to her own experience with miscarriage, but her point rings true for all aspects of all things uterine. How much do you really know about what goes on in the delivery room, apart from the sterilised version you see on TV? Are you one of the two-thirds of women unable to identify the individual parts of their own genitals, and yet perfectly able to detail those of a man? With all the drama surrounding women sharing their experiences online and being lambasted for contributing to tokophobia, we're here to join the movement and shine a floodlight on the real life experiences of women and their uteruses. Plus, we offer insight to working with children day in, day out and get to grips with the fascination with royal babies. To our contributors, thank you. To our readers, enjoy. â–

Jade Sterling Editor

‘Communicate, even when it’s uncomfortable or uneasy. One of the best ways to heal is simply getting it all out.’ ~ unknown

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FIRST TH I N GS F I R ST A crash course on the female body

08 Everything you need to know about the uterus 14 The ovaries 16 The ins and outs of the vagina 21 The hymen debunked

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EV ERY T H I N G YOU NE ED TO KN OW A BO U T T H E U T E R U S At only 3 inches long and weighing just 60 grams, its role far outweighs its size.

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espite being the source of all life, the uterus or womb isn’t a flashy, attentionseeking organ. At only 3 inches long and weighing just 60 grams, its role far outweighs its size. Sitting pretty, tucked away behind the bladder, it allows 211 million women to get pregnant every year, but is also the source of pain, bleeding and conditions like endometriosis. For an organ so vital to motherhood, it’s likely you don’t know much about your own beyond what gynaecology appointments have revealed.

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What does the uterus do?

any scar tissue. We don’t even know why we bleed in the first place. While live birth is a part of the mammalian experience, only humans, fruit bats and elephant shrews menstruate on a regular basis. All other animals reabsorb the endometrium. One theory is that menstruation protects us from abnormal pregnancies; as human gestation takes so long and requires so many biological resources, rejecting all but the most viable could be a protective feature.

From abandoned theories about the uterus travelling around the body and causing hysteria, we now know the uterus sits low in the abdomen, and stays there thanks to the muscles and ligaments holding it in place. It is connected to the vagina by the cervix and receives unfertilised eggs from the ovaries via the fallopian tubes, which are connected to both sides of the uterus. The uterine wall comprises the endometrium, which thickens and sloughs during the menstrual cycle, the myometrium, the muscle layer, and the perimetrium, which covers the outer surface of the uterus. The uterus accepts a fertilised egg, which implants in the endometrium and derives nourishment from the placenta, which grows for this purpose. As the baby grows, the uterus stretches more than 500 times its original size to accommodate it, producing the bump. The uterus is a baby’s first home and returns to normal within six weeks after birth. While it’ll appear the same as before, it’ll be slightly roomier after your first pregnancy, and the muscles will be more toned and flexible— thanks to the workout they just went through— which is why second pregnancies may show sooner and labour may be easier and quicker.

What is a tilted uterus? Also known as a retroverted or retroflexed uterus, 20 to 30 percent of all women are the proud owners of a tilted uterus. In the rest of the population, the uterus tips forward and points towards the stomach or straight up; when a uterus is tilted, it points towards the back instead. This is nothing to worry about and is simply a ‘normal anatomical variance’ caused in most cases by your genetics. In some rare cases, some women develop a tilted uterus when the ligaments that hold their uterus in place have become weakened during pregnancy, or due to complications with fibroids or endometriosis. A tilted uterus is unlikely to give you any side effects or display any symptoms other than some difficulty using tampons in some women—as such, you’ll likely not know if you have one until the discovery is made during a gynaecological exam. You certainly won’t need to worry about it affecting your fertility, as a woman with a tilted uterus is just as likely to conceive as anyone else, and during pregnancy, the only differences you might encounter would be an increase in back pain, or the uterus leaning on your bladder, making it hard to fully empty. By the tenth or twelfth week, a titled uterus will typically straighten out as the uterus ‘pops’ forward into the abdomen to accommodate

Why do we have periods? Unfortunately, no-one knows. There are theories, and a 2015 paper compiled plenty of studies to confirm we have far more questions than answers. We know that a decline in progesterone triggers menstruation and that the endometrial coagulation system is part of what stops the bleeding. But we don’t know exactly what causes the bleeding to stop, what regulates inflammation during a period, or how the uterus repairs itself without creating

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your growing baby. You’ll most likely also have a completely normal labour and birth experience as it’s extremely rare a tilted uterus will cause any difficulty delivering.

a rough side that attaches it to the womb. Following childbirth, you need to then pass the placenta as it detaches from the uterus— as the womb contracts to deliver the baby, the placenta becomes strangulated between the three layers forming the uterine wall. Once the baby is born, the uterus continues contracting, but the placenta can’t change its shape or size, no longer fits, and begins to separate. Out comes the placenta; and yes, people do eat it post-birth.

What is a heart-shaped uterus? Most uteruses are shaped like an upsidedown pear, with the fallopian tubes attached to the widest part on either side at the top. A heart-shaped uterus looks like it sounds: the main uterine cavity—the fundus, where the baby develops—features a little indent at the top where the two fallopian tubes meet. It’s a simple uterine anomaly affecting just one to two percent of women, and having one isn’t necessarily a bad thing. Many women will go their entire lives unaware of their heartshaped uterus as it has no symptoms or effects on your periods—in rare cases, you may be at higher risk for endometriosis—but your risk of preterm delivery or breech delivery is increased. Fear not though: if you do have a heart-shaped uterus, a pregnancy that’s closely monitored will be just as likely to be successful as any other.

When it functions normally, the placenta provides the baby with a constant stream of nutrients and oxygen, but when things go wrong with the placenta, they really go wrong. If it’s under-invasive, its connection to the mother’s blood isn’t strong enough, meaning the baby won’t be getting the nutrients it needs to develop, and this could lead to preeclampsia. If it’s over-invasive, it can infiltrate the uterus and other organs like a cancer. Finally, it can detach from the uterus before delivery, in a complication known as placental abruption, causing heavy bleeding in the mother and removing the source of the baby’s oxygen and nutrients.

What is the placenta?

The word 'placenta' means flat cake, named The placenta is a transient organ created only after its flat round shape, and it’s believed this during pregnancy. It is one of the least studied is the inspiration behind the traditional round and least understood organs, and could hold shape of a birthday cake! the secrets to enhancing immunology and transplant medicine. The placenta acts as the Scientists are still discovering what a lungs, kidneys, and liver for the baby, as well normal placenta is and how it functions, as the gastrointestinal, endocrine and immune and new technologies are allowing us to systems. It feeds and protects the baby from safely study it during pregnancy. Learning infections and the mother’s immune response, more about the placenta could lead to new while extracting the blood-soluble waste the treatments to improve the health of the foetus produces. Weighing around 500g, it’s mother and child during pregnancy about as thick as a medium-sized steak with and provide insights into other areas of a smooth surface where the baby grows and research including organ transplantation. ■

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Your uterus allows a connection with your unborn baby. At around 18 to 25 weeks, your baby can hear and, while muffled, the sound that travels through the uterus is your baby’s first contact with the outside world, which is why you’re encouraged to talk to your bump. At just ten weeks old, your little foetus can feel your heartbeat, and that’s why your new-born can be comforted by resting on your chest—your heartbeat is a reminder of being in the womb.

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THE OVA R I ES The two walnut-sized organs sitting on either side of the uterus are the hormone and egg-producing powerhouses keeping your reproductive system going.

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Whether you’re pursuing motherhood or resolutely avoiding it, your ovaries are producing oestrogen and progesterone to regulate your menstrual cycle and provide your womanly figure. Your ovaries also produce the testosterone your body needs for a healthy sex drive. Every month during ovulation, either the right or left ovary produces a single mature egg to be fertilised (non-identical twins are a different matter!)

of the ovary, the follicle and the ovarian surface open up to allow the egg to drift out. Progesterone production steps up to thicken the uterine lining while the egg makes its way through the oviducts and fallopian tubes into the uterus. It can take three to five days for the egg to reach the womb and, if unfertilised, it joins the uterine lining as it sheds via monthly period. At the end of the period, the whole process then starts over again.

When you’re born, your ovaries contain around 1 million ovarian follicles, each with a hollow ball of cells and an immature egg.

The ovaries are susceptible to various issues, including low body weight. When women lose too much weight or female athletes aim for a body fat percentage that is too low, the ovaries can cease to work and stop producing the hormones and eggs. Once you gain some weight back, the ovaries should begin to function again. They can also be susceptible to cancer, with ovarian cancer often called the ‘silent killer’. It can be one of the hardest to detect as symptoms are very commonplace, including bloating and abdominal pain. Luckily, if it’s found early, ovarian cancer is treatable. Ovarian cysts are the most common complaint with ovaries; fluid-filled pockets which occur when the egg is not properly released or the follicle does not dissolve properly. Most are harmless, and will go away on their own, but they can cause trouble if they bleed, twist or rupture. The most common hormonal disorder among women, polycystic ovary syndrome develops when numerous cysts remain on the ovaries. The cysts themselves are not harmful, but the hormone imbalances they may cause can lead to serious health problems. ■

As you grow up, about half of these follicles are absorbed by the body, and once your menstrual cycle begins, you’ll have about 400,000 left to play with. Although only one egg usually fully matures during ovulation, between 10 and 20 follicles begin the process of maturation monthly and are reabsorbed before ovulation occurs—like a race to mature first. The ovaries even grow during ovulation as the follicles mature but this is only temporary— once you’re through the menopause and your ovaries retire, they’ll literally shrivel up. The oestrogen produced by the ovaries fluctuates over the menstrual cycle, and ovulation starts when oestrogen drops. The pituitary gland then increases its secretion of follicle-stimulating hormone, which prompts the follicles to begin maturing. Once the matured egg has eased towards the surface

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T HE INS A N D OU T S OF THE

vagina

Lady garden, women's bits, down there, girly parts... velvet glove. Let's stick with 'vagina'.

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hockingly, a 2014 survey by The Eve Appeal found two-thirds of women were unable to identify the parts of the vulva, but 60 percent could correctly label a diagram of male anatomy! There’s plenty about this vital piece of reproductive machinery shrouded in mystery but no more: here’s everything you need to know about the vagina.

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Let's get specific

Name-calling

While many people use vagina to refer to the whole downstairs area, both inside and out, the vagina is actually just the muscular canal connecting the uterus, via the cervix, to the outside of the body. All the external parts are the vulva, including the labia majora, labia minora, and the clitoris. The vagina is a potential space, meaning it’s not open all the time but can stretch and widen during sex or childbirth. You’re not walking around with an open hole in your body, rather the walls are collapsed on each other and widen when needed. It’s around 10cm long and can stretch another 5cm during sex. And having a baby— or lots of partners—certainly won’t ruin it. The vagina can stretch enough to allow a baby through and can also snap back into shape. It’s incredibly resilient.

There are hundreds of different slang words for it, from the hilarious to the crude to the obscene, but the word ‘vagina’ wasn’t used until 1682. Before then, the most common term was the most obscene we have today, but even that word only became a swear word 100 years ago. Let’s just stick with ‘vagina’. Believe it or not, the first film to use the word ‘vagina’ was Disney’s ‘The Story of Menstruation’ released in 1946.

Cleaning As obsessed as our culture seems to be with making cleaning products for the vulva and vagina, you really don’t need anything other than water and a mild soap. You definitely shouldn’t be putting anything inside to clean up there: no douching, no scrubbing and no scented products. There’s a very delicate ecosystem of yeast and bacteria in the vagina which is supposed to be there and supposed to be in balance. Douching disturbs the balance and the natural acidity which puts you at risk of infections including pelvic inflammatory disease as well as irritation. There are glands in the vagina that secrete discharge to keep it clean so just leave it alone. Some odour down there is perfectly normal and your personal scent is unique, varying according to your menstrual cycle, diet and hydration levels. It’s not supposed to smell like roses but if there is anything unusual or foul, you need to see a doctor. Scented soap is not the answer and neither are vaginal steams as popularised by Gwyneth Paltrow. All these cleaning products not only perpetuate the myth that vaginas are dirty (which is just wrong), but they can also

Am I normal? Yep. Every vulva looks different and variations in what’s normal range from the size of the clitoris, to the length and thickness of the labia. If you’re one of the 15 percent of women who’ve never taken a good look with a mirror, it’s time to change that. Get well acquainted with how you look, feel and smell and you’ll be better able to notice when things change. Besides, research shows the more comfortable you are with yourself, the more sexually satisfied you’ll be. Doctors won’t consider anything to be abnormal unless you’re experiencing trouble with chafing, infection or inserting a tampon. At the same time, how you choose to decorate is completely personal. Waxing, shaving, trimming, piercing, tattooing, going au natural: this is your choice.

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cause health problems. Seriously, just leave it and anus are all in close proximity; intercourse alone. can cause bacteria to make its way into the bladder, where it can give you a urinary tract Let it breathe infection. Urinating after sex can help cleanse the urethra and while it’s not the most sexy of A moist and warm environment is the perfect activities, it’s a whole lot sexier than a UTI. breeding ground for bacteria beyond the Some theories suggest the female orgasm beneficial microbes you want in there. Stick can make you feel the need to urinate to help to cotton underwear for best breathability. facilitate this! If you are itching a bit, it doesn’t necessarily Getting better with age mean you’ve got a yeast infection. Get yourself checked out as the wrong medication can easily make things worse—and you can’t use yoghurt As with all things, your vagina changes with to cure a yeast infection. Putting a little natural age. In your 20s, your labia may shrink and (plain and unsweetened!) yoghurt on the itchy become thinner as subcutaneous fat decreases areas may relieve the itch but it’s not going to with age. In your 30s, hormone shifts may cause the vulva to darken in colour. In your treat the actual infection. See a doctor. 40s, lower oestrogen levels may change the pH Discharge balance, causing inflammation and thinning and drying. It’s not all bad though. The old There is no normal amount of discharge: adage ‘use it or lose it’ applies here too: women some people have lots, some people have very who have sex on a regular basis help keep their little. In the middle of your menstrual cycle, vagina in good shape longer—good shape secretion increases and it’s generally clear and for penetrative sex, that is. If you’re an older stretchy. At other times of the month, it may woman who enjoys sex, continue to have it be thicker and whiter. It’s nothing to worry regularly; if you don’t enjoy sex, don’t worry: about unless it’s clumpy, grey, yellow, or green. your vagina is just as healthy and won’t benefit from forcing it. In 1998, the US National Peeing Council on the Aging found 70 percent of sexually active women over the age of 60 said At the risk of patronising, there are three they were as satisfied, or even more satisfied, separate holes down there—remember the with their sex lives as they were in their 40s. two-thirds of women who couldn’t label their So, while your 20s and 30s may be your prime own genitals? In women, the urethra, vagina years, the best may well be yet to come. ■

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THE H YM E N D EB U N KE D Virginity is not protected by a cling film-like barrier. Hymens can’t be broken. There is no barrier sealing off the vagina; if a girl’s hymen is completely intact, that’s a medical concern and she’d need a hymenotomy to allow menstrual fluids and other discharge to leave the body. Fact. The hymen is not some mystical evidence of virginity—it’s a ring of stretchy tissue leftover from the formation of the vaginal canal during foetal development. In the womb, the hymen might be a protective barrier from bacteria, but other than that, we have no idea why we have one.

tissue will have worn away, it’s possible there’ll be a little left, and combined with the lack of preparedness and finesse that comes with a first time, this tissue could be aggravated. All bodily tissue has a blood supply. As for the pain, many women expect sex to hurt, which may become a self-fulfilling prophecy. Natural anxiety around sex can interfere with lubrication and poor sex-ed usually means neither party is aware enough of foreplay: poorly lubricated sex equals painful sex. Rushed, poorly lubricated, piston-like sex (as learned from porn) might abrade the sensitive Oestrogen naturally causes the tissue to stretch vaginal tissue enough to cause bleeding. and wear away as you age and develop, and its shape and size is as unique to you as anything Don’t forget: for women in cultures where else. By the time many women have sex, the proof of bleeding is required, many brides hymen—or vaginal corona as it’s now named— take no chances. They find other ways to may have stretched naturally and worn away produce enough blood to satisfy tradition and from any number of daily activities, including perpetuate the hymen myth. â– tampon use. It is not a physical symbol of virginity. You can’t pop your cherry or be deflowered: it’s a myth and an overrated and harmful one at that. Bleeding during your first time is a culturally accepted and expected phenomenon; new husbands were expected to produce bloody sheets to prove they’d both married a virgin and consummated that marriage. đ&#x;¤Ś If it’s nonsense, why do some women experience the pain and blood of what they presume to be their hymen breaking? While most of the 21

TOO P O S H TO P U S H OR JU ST P L A I N TERRIFIED? Are parenting forums really contributing to a rise in tokophobia?

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hat do you know about labour and childbirth? There’s pain involved, it can take a while and all the pushing might cause you to have a bowel movement. Did you also know having an epidural means you might also need a catheter; that the skin of the perineum may tear; you may well give birth on all fours; and you also need to give birth to the placenta?

A 2017 study found 14 percent of women suffer from tokophobia and this number has been rising steadily since 2000.

This could well be attributed to the proliferation of the internet and storytelling online. Some experts have described it as a tsunami of negative birthing stories, joined by celebrities telling the truth about their pregnancies to huge audiences: Beyoncé spoke of her issues with preeclampsia, If you’ve never been pregnant before, it’s likely Serena Williams wrote about her near-death you won’t know much about pregnancy or experience giving birth, and Caitlin Moran has labour beyond what you’ve seen on TV—if you written about her traumatic birth. have been pregnant, in this age of instant access to information, it’s likely you’ve devoured as Women need these platforms and the much knowledge as you can about every aspect. opportunity to hear first-hand experiences of an Search engines are the first port of call, and event they’ll likely share: dismissing their right to they’ll quickly lead you to parenting forums like this information is problematic to say the least. Mumsnet and Netmums. Type anything into Forums and the internet provide vital spaces for the search bar and thousands of mums will have women to share their experiences, both good already discussed it; you’ll find the answers to and bad, after years of hush-hush surrounding all your questions, stories about every milestone childbirth. and step of the way, advice for new mums from those with experience. They can be invaluable to Understandably, a great deal of messaging about any woman feeling a little worried about her new labour focuses on the positive, but this lets the women who have traumatic experiences down. role in life. Why didn’t anyone tell them how bad it could But the help and support comes with a side be? To prevent this fear! But women have a right effect that was—for some reason—unexpected. to this information; you are absolutely entitled to Academics warn that parenting forums are know the truth—to know that it’s probably going contributing to a rising fear of childbirth. Despite to be absolutely fine, but if it isn’t, this is what feeling well acquainted with the idea of labour could happen. thanks to programmes like One Born Every Minute, the experience is sterilised and portrayed Actress Emma Thompson waded in saying the as the miracle of life. Miraculous as it may be, the ‘lies’ women hear about the pain of childbirth are no-holds-barred approach to storytelling found making them ‘terrified of that pain’, leading to a on internet forums is proving it’s not always plain lot of elective C-sections, without the motherssailing, with ‘horror stories’ contributing to the to-be realising the effects that such a procedure can have on the body. rise in tokophobia—phobia of childbirth.

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Miraculous as childbirth may be, the no-holds-barred approach to storytelling on internet forums is accused of contributing to the rise in tokophobia in modern women.

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‘The pain of giving birth is now “optional” and yet there’s no honesty about what that option can actually do to your body. It’s odd how frightened we’ve been made to feel about the pain of it.’ Does Emma Thompson have the world’s highest pain threshold? Or is she unintentionally making two very important points? First, the concern that women don’t fully understand the impact a caesarean has: inundated as we are by the normality of being ‘too posh to push’, caesareans can seem the easy way out, for mother and baby alike. No one talks about the six week recovery time, the layers of muscle that need to be sliced through to reach the uterus, the staples holding your belly together… Second, the pain of childbirth should be optional. Make no mistake: women everywhere are aware it has to hurt pushing a baby through a very narrow birth canal. Enter the epidural. There are safe, effective painrelieving drugs available—avoiding pain does not mean avoiding labour. Besides, 75 percent of maternity units refuse elective C-sections. While Thompson meant well, comments like this simply contribute to the feelings of inadequacy a woman may be prone to surrounding natural birth. Already frightened, the last thing she needs is pressure from a far-off celebrity to ‘push through the pain’—or worse, refuse a C-section if needed. There’s little criticism of public figures swaying our opinions of pregnancy and childbirth, but plenty of focus on normal women sharing their experiences—odd that. A recent survey by Channel Mum found 92 percent of mums actively seek out birth stories when they are pregnant, and 69 percent find it helpful and empowering. Just 29 percent said it made them more fearful. If so many women want honest and frank accounts, why has so much been shrouded in secrecy all this time? In

societies around the world and in our history, birth has been a communal experience: women would gather to help and support the mother through pregnancy and labour; would be sharing tips for conception, avoiding morning sickness, and inducing labour; would share the journey. Just as it takes a village to raise a child, it takes a community to make one too. These days, pregnancy and birth can seem a sole endeavour with media depictions of birth making it a clinical event—your water breaks, you rush to hospital, you scream and push twice and voila: baby. Parenting forums have stepped into the gap, providing that community of advice and stories, where women can freely discuss their experiences, thoughts and feelings in a safe place. Reassurance, guidance, expert advice, and support combine to reproduce the birthing community of old.

One thing no one seems to be asking: why do so many women have ‘horror stories’? Does the horror stem from unexpected complications that no-one warned them about, when it’s our duty to impart medical information about everything that could happen during birth? If shielding women from the truth that complications can happen is meant to help them feel more reassured and relaxed about their pregnancy, we’re doing them a great disservice and putting them at risk in the delivery room. It’s more frightening to consider how much we haven’t been told about something so intrinsic to motherhood—and for some, womanhood. As for increasing tokophobia rates: remember the stories we like to share are inevitably the unusual stories—emergency operations, blood and pain shared in hushed, conspiratorial tones make for tales of horror. Everyday, normal, boring births don’t merit talking about in comparison to these

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The word 'gossip' originated with people attending childbirths. Friends of women in labour were called gossips, or 'God's sibs (siblings)'. As the first to know how the birth went, the child's gender and all other facets of the experience, the meaning of the word evolved from 'close to God' to 'rumour or report of an intimate nature'. 27

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Thank Queen Victoria for making epidurals commonplace. Before the mid1800s, it was believed if you couldn’t withstand the pain of labour, you wouldn’t withstand the hardships of motherhood. In 1853, Queen Victoria demanded ether, the ‘blessed drug’, while in labour in 1853, making pain relief acceptable during childbirth worldwide.

gory events and they don’t stand out in a forum of experience stories. Some women can speak of the life-changingly beautiful and intensely primal moment they met their baby. You’re likely looking forward to seeing your baby for the first time, the little bundle of joy you’ve spent all these months growing—you expect that moment to be profound and emotional. When this completely normal expectation is realised, your story can seem insignificant and inappropriate next to someone else’s traumatic or heart-breaking experience.

Women who have suffered abuse or rape fear the experience of childbirth will cause them to revisit the distress and helplessness they have already experienced; women who have already suffered during childbirth fear re-traumatisation. This is far more complicated than a fear of pain causing a rise in elective C-sections. Reducing the sharing of experiences to ‘oversharing’ minimises the reasons behind a pathological fear experienced by 6 percent of pregnant women and blaming ‘gossiping women’ for scaring new mothers is both inaccurate and plain wrong.

Discussing a normal childbirth beyond the ordinary doesn’t excite audiences or encourage debate the way a more harrowing story can.

Oversharing on social media may have been instrumental in the rise in fear of childbirth but closing down discussions on supportive female networks isn’t the answer. Knowledge is power when it comes to anything—including giving Not to mention, tokophobia is the pathological birth. fear of pregnancy so severe it can impact a woman’s decision to have children: if you’re Once you understand what’s happening to reading these stories, you’re likely already your body and why, you can cope better. More pregnant. There’s more to tokophobia than the education on the potential complications simple fear of childbirth anyway: more intense is needed; frank and honest discussion of in women who haven’t had children, it’s fear of experiences; unfiltered advice on what to expect the unknown; this fear of pain may be a way when you’re expecting. If a woman wants to of expressing something more complex. Some research real-life experience, she has the right studies show women fearful of childbirth lack to do so—if the only place to find raw truth is a faith in their obstetric team, worry about their parenting forum, then we’re failing to adequately own incompetence, and are scared of dying. prepare women for pregnancy and childbirth. ■

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Childbirth is natural and the likelihood is you’ll have a perfectly normal experience. You have the right to all the information you need about your pregnancy: don’t let anyone dissuade you from accessing it, and don’t let the worst-case scenarios scare you off. 29

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T HE FAS C I N AT I ON WITH ROYA L B A B I ES Little whips the media into a greater frenzy than a royal baby.

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very detail of their life is pored over: the birth, the name, the hair colour, the first step, the first tooth, the first word—nothing about them escapes public scrutiny. We speculate whether their mother is even pregnant, analysing the shininess of her hair, whether her fashion choices or body language are hinting at pregnancy. Her morning sickness makes front pages, her every action is dissected—after all, it’s her job to produce an heir and a spare. These tiny babies represent more than a new member of the Royal family: they’re a symbol of continuity, a bulwark against changing social tides. They’re the future of the nation and are welcomed with great excitement and expectations from a waiting world. We may have come a long way since the presence of the Home Secretary was

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deemed necessary at the birth to ensure the infant was not a changeling—now the world’s media passes judgement on the latest bundle of joy. Royal babies have always been a subject of intense fascination, and none more so than Prince George, by virtue of the times. At 4.24pm on 22 July 2013, there was a new heir: the third in line to the throne. The following evening, the prince was presented to the biggest media circus in royal history outside St Mary’s Hospital in London. The attention beforehand was understandable: Prince George was the first child of Prince William and Kate Middleton; until the gender was announced, Parliament was ready to change the succession laws to allow a princess to inherit the throne; the nation was waiting for their first glimpse of their heir to the next generation of royals. Hundreds of TV crews and reporters lined

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up outside the Lindo Wing of St Mary’s for almost and bookies alike pondered his name, and people a month—the international media attention was all around the globe clamoured for the first frenetic. glimpses of the latest heir. The royal family itself shoulders part of the blame for this attention— And too much for Kate Middleton. Not only during the Victorian era, Britain was the richest were her pregnancies marred by extreme nation in the world, an ever-expanding empire morning sickness—known as Hyperemesis embracing a quarter of the planet. Gravidarum—she couldn’t have expected the This power needed a mythology: intensity of the focus on her and her bump. Her the concept that the royal family first child; while she had experience of being symbolised all the strengths of the in the public eye, it’s a different matter entirely nation stepped in. trying to navigate your first pregnancy under such scrutiny. She was exhausted and frightened by the constant attention and then paraded in Fuelled by the emergence of the media-savvy front of the media just a day after giving birth. royals including Princes William and Harry, Media cooed over her perfect hair and makeup, and a frankly astounding public relations team, her choice of dress and swaddling blanket for the royal family enjoys goodwill and fascination Prince George. She didn’t ‘stop for a few quick around the world, despite wielding no real power photos’ with her husband: the Duke and Duchess in this day and age. Their position is largely of Cambridge performed their 21st century ceremonial and it’s that traditional aspect we respond to. They’re an institution; a symbol of Royal duties. the nation’s longevity and splendour. The sheer Kate’s reaction was nothing new: in 1982, the volume of 24/7 media outlets helps: audiences attention had frightened Princess Diana too. As worldwide can feel part of the story. Prince soon as the car carrying her and her newborn Charles and Princess Diana’s divorce turned the son (again: her first child) had turned the corner family into a global soap opera; once we were away from the crowds at St Mary’s hospital, she familiar with the characters, we wanted to know what happened next. When Princess Diana burst into tears. died in 1997, the nation mourned alongside the Amid the pomp and circumstance, young princes, and then watched them grow up. there’s something archaic and strange We waited with bated breath for a new princess about declaring any baby’s arrival to step into Diana’s shoes—it helped that Kate newsworthy. fulfilled the fairy tale, a commoner marrying a prince. The media focus has made us care about The list of babies who accomplish something their lives; it’s had a humanising effect on a once simply by virtue of their birth is very short. unreachable and closeted family. There’s one: Louise Brown, the first test-tube baby. The family aspect plays a huge role—babies are adorable. It had been a long time since we had a Prince George was born into a world where new royal baby and a new family to coo over. This celebrity worship and royal worship have collided; new generation of parents comes at the perfect celebrations surrounding his birth injected $400 time for a media storm: social media affords us million into the British economy, news tickers constant insight and discussion opportunity, 32

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‘If you are going to have a monarchy, you have got to have a family—and the family has got to be in the public eye.’

paparazzi can be found on every street, and the younger royals are more open than ever before. We have access to this family and that access fans the flames of our fascination. An injection of cuteness in an otherwise pompous occasion (Grace van Cutsem covering her ears on the balcony at the wedding of the Duke and Duchess of Cambridge, scowling adorably; Prince George tossing aside the toy kangaroo presented to him in Australia) and a candid snap of a delighted child during an official tour (Princess Charlotte overjoyed at the sight of balloons in Canada) work wonders in humanising the royal family. These children remind us that amongst the glamour and the fantasy, the crowns and the ball gowns, the royals are just people, raising their own little families in their own way.

We’re on a first name basis with these members of royalty: Harry and Meghan, William and Kate.

~ Prince Philip

There’s also no choice but to become interested: constant media exposure creates a feedback loop. As long as there are people interested in celebrities, media outlets will continue to cover them—the more a celebrity is in the media, the more people notice them. The royal family is no different and even though celebrities worldwide live in enormous houses and enjoy extravagant lifestyles, only royals live in castles and enjoy the fairy tale lifestyle. We grow up on stories of princesses in castles and here they are in real life. They help us escape from the everyday mundane—we can live the fairy tale vicariously. The major royal events are celebrations— injections of happiness in difficult times. The constant media cycle presents us little more than sensationalism and pessimism; announcing Meghan Markle is expecting gives us a respite from the headlines and lets us enjoy pictures of happy couples and children.

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Royal babies are a tangible part of our nation’s history; they’re the next chapter in the sagas of the kings and queens of Great Britain. They connect us to our history and traditions—to our identities as subjects of the Crown. We can romanticise our history and our culture through the royal family; they’re a stabilising force in turbulent times. Queen Elizabeth is living history: she’s been the head of the government through the 20th and 21st centuries. She’s the only ruler most Brits have ever known—that one day she won’t be is almost unthinkable. And yet we look to the future with each new child.

The problem with all this? Celebrity pregnancies teach women how to be pregnant. We are inundated with talk of their svelteness, their clothes, their fresh and calm approach. No sooner has a baby been popped out than we’re commenting on how long it’ll take her to ‘snap back into shape’, as if this woman’s weight is her biggest concern right now. For Kate Middleton, the media focus made it a concern. When the Duchess of Cambridge attended a volleyball game, Kate took a leap for the ball in wedges, skinny jeans and a top that floated upwards as she did: a flat stomach greeted the world just 89 days after the birth of her first child. Rather than commend the Duchess on her first solo public engagement since the birth, or her pretty amazing volleyball skills in skinny jeans and fiveinch heels, the focus was on her figure—and how she did it. The message to women everywhere: if she can do it, so can you. The standard has been set, ladies.

themselves. Royal babies are trendsetters from the get-go: when Prince George met President Obama, in 2016, dressed adorably in a dressing gown from British brand My 1st Years, it sold out within minutes. The receiving blanket wrapped around Princess Charlotte as she was carried out of the Lindo Wing was another instant sellout. This isn’t a new phenomenon: when the Duke of Windsor wore a straw boater as a child back in the 1980s, he single-handedly revived the Nottingham straw industry. Their sartorial choices will be scrutinised for the rest of their lives: who can forget that fascinator Princess Beatrice wore? These children didn’t ask for this; does anyone care that Prince George appeared shy and uncomfortable on the way to the Lindo Wing to meet his newest sibling this year? Does anyone care these children may not be among the naturally charismatic figures that handle the limelight with aplomb—have we all forgotten they’re children? The intensity doesn’t fade as they age either: we will follow the rest of their lives and judge their clothes, actions, and choices. Born into the highest family in the land through no choice or fault of their own, they will never know privacy.

Britain is far from becoming a republic and the pomp and circumstance surrounding anything Royal is too comforting to deny. From the official declaration of the birth on an easel outside Buckingham Palace, too tiny to read through the sky high fence, to the town crier in all his garb announcing the gender to the waiting public. Royal life represents a welcome reprieve from our day-to-day, a diamond in our dull grey existence. Once the mother has done her job and produced And diamonds usually survive: our fascination an heir and a spare, we can turn to the children shows no signs of ending soon. ■

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‘I want George to grow up in a real, living environment. I don’t want him growing up behind palace walls; he has to be out there. The media make it harder but I will fight for them to have a normal life.’

~ Prince William

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L IM I T LES S We're looking for your stories of amazing women doing amazing things. Have you started something amazing? Are you a champion base jumper? An experienced skydiver? In a band? Have you just run your first marathon? Just graduated? Have you found a new job? Changed careers completely? Or started your own business? Do you know someone who has? The December edition of the -ette magazine celebrates achieving your goals against all odds; reaching heights you never thought you could; punching through glass ceilings and showing the naysayers what's what. Limitless is exactly that: it's going for it no matter what. If you've got a story to tell, we want to hear it! Get in touch on Facebook, Instagram, through our website or via email and tell us your stories. â– @hyphenette H

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THE RE A LI T Y O F P RETE R M B I RT H No first time mother-to-be expects to find herself in the delivery suite after just 25 weeks of pregnancy.

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o first time mother-to-be expects to find herself in the delivery suite at the end of week 25 of her pregnancy but in October 2006 I found myself in the unfortunate situation of being one of those ladies who contribute towards the 4500 babies born too early in Ireland each year. My pregnancy had been marred with complications and suffering a placenta abruption—a condition that could cost us both our lives—resulted in a 160 mile dash to a tertiary unit where our daughter, Amelia Faith, was delivered by emergency caesarean section. She weighed just 780 grams.

The delivery room was deathly quiet as one faction of the army of medics fought desperately for nine minutes to breath life into Amelia’s tiny skeletal body and the other half fought to save my life. Unlike most births, I did not get to see or hold my daughter after her birth and the physical

and emotional emptiness that ensues following an emergency delivery was compounded by the stark reality that my daughter might not survive and might never know the loving touch of her mother in life.

24 hours after her birth, I was finally brought to the Neonatal Intensive Care Unit to meet Amelia. As I stood outside the ward and peered at the 10 incubators in the room—each housing a baby smaller than the next—it struck me that I didn’t even recognise my own flesh and blood. Nobody and nothing could have prepared me for the journey that lay ahead: the discharge home from hospital three days after birth without my child; the daily two hour commute each way to spend 14 hours sitting beside Amelia’s incubator

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As I stood outside the ward and peered at the 10 incubators in the room, it struck me that I didn’t even recognise my own flesh and blood.

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desperately wanting to reach in to touch her; the heart-stopping fear flowing through my body each day as I emerged from the hospital lift to walk the long lonely corridor to the NICU, not knowing what crisis we were going to face today; the dark thought that today might be our last together.

guilt that the pain and suffering that my little girl had had to endure was entirely my fault. The irrational guilt that accompanies a preterm birth cannot be quantified and twelve years later that guilt still lives within my heart—but I have learned to embrace it as part of our journey and it no longer owns me.

Day after day: praying she would overcome the myriad life-threatening infections; watching her endure a multitude of painful medical procedures; screaming inside on each occasion that she had to be resuscitated; witnessing eight life-saving blood transfusions and hoping she would find the strength to defy the odds that at times looked very much stacked against her broke every ounce of my physical and emotional being. The heartache of leaving her each night as we travelled home to our empty house is indescribable.

Fast forward three months and on Christmas Eve 2006 we got what most families might consider the best Christmas present ever… we took our little girl home. I must admit there was a moment when I thought that the staff had made an error in their decision to release Amelia. A part of me hoped they would quickly realise their ‘mistake’ and the ‘normality’ of life being hooked up to a whole host of machines would quickly be resumed. Our NICU stay had institutionalised us and without realising it, we had grown accustomed to every aspect of Amelia’s life being monitored or recorded.

We wouldn’t be home from the hospital more than five minutes before I would contact the NICU about Amelia’s condition. Such was the gravity of the situation that every night as I bid her farewell a part of me was preparing to accept that this would be our last time together. Sleep or what little sleep I managed to grab refused to ease the pain of failing my daughter. Setting an alarm to wake me every three hours so that I could express breast milk for a child I had yet to hold was beyond surreal—yet this was one of the few things that I could do for Amelia in the hope it would help her to survive. Four weeks into our NICU stay—after several late night dashes to her bedside when she had taken a turn for the worse—we finally got to hold Amelia for the first time. She still weighed only 900 grams and—honestly—even as she lay skin-to-skin against my chest I couldn’t feel her. A moment which should be filled with joy and gratitude was tainted by the feelings of pure

We had become utterly dependent on the highly specialised medical team. Suddenly, we found ourselves in the role of Amelia’s carers: a task neither of us felt qualified or confident to take on. Amelia had been diagnosed with Chronic Lung Disease and her breathing—or lack of it at times—continued to be an issue for the first twelve months at home. She had to be attached to a breathing monitor by night and we got quite adept at jumping out of bed when the alarm to indicate that she had stopped breathing would activate in order for one of us to restart her breathing again. As with many preterm infants, feeding has always and continues to be an issue for Amelia. Her growth rate was delayed as a result of her feeding issues and for a number of years we found ourselves embroiled in a vicious circle of specialists all trying to get Amelia to eat. Finally at age three, we discovered Amelia suffered from

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Four weeks into our NICU stay, we finally got to hold Amelia for the first time. She still weighed just 900 grams.

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oral aversion, most likely related to her prolonged time on a ventilator during her first four weeks of life. Since then we have adapted our approach to her feeding issues.

NICU and for the first three years of Amelia’s life, I lived with a knot of fear in the pit of my stomach each time she fell ill with a respiratory complaint. Her immature immune system resulted in many bouts of illness and hospitalisations in those early A major concern to Amelia’s medical team years but this too has resolved over the years. was a haemangioma which was growing Amelia is now 12 years old and has aggressively on her left foot. Preterm babies are done remarkably well for a baby of her more predisposed to developing haemangiomas gestation. and indeed, Amelia has several on her body. However, the speed with which her foot growth was developing led her medical team to speculate She has dyspraxia, sensory processing disorder that she might end up losing a part of her foot and some balance, social anxiety and eating and it would be unlikely that she would walk issues but to the outside world she is a happy normally. Thankfully yet again—and with no pre-teen surrounded by loyal and understanding medical intervention—Amelia defied the odds friends. on that score and despite having a mis-shapen and discoloured foot and losing part of her little Looking back at her childhood, I often remark toe, she learnt to walk at age two and this anomaly how I would have reacted on December 24th has not prevented her from participating in 2006 had I been aware of the many sleepless nights, countless bouts of illness, years of hospital sporting activities. appointments and early intervention therapies Having a premature baby in your house during that lay ahead. I certainly found inner strengths I the winter season is one of the most isolating never knew I had but would I ever want to retrace situations to find yourself in. A virus called my steps again… never in a million years! Our Respiratory Syncytial Virus must be the most life-changing experience of having a preterm dreaded three words any parent of a premature baby and navigating the oftentimes uncertain baby can hear. This virus surfaces each year waters of years of medical follow ups, inspired around September and lasts until April and is me and five fellow parents of premature babies life-threatening for premature babies. Prevention to set up The Irish Neonatal Health Alliance. ■ is the only guaranteed cure but keeping a baby in quarantine for nearly seven months is an Mandy Daly impossible task. I had witnessed several babies succumb to this virus during my time in the

Families with preterm babies can now have access to the support and care they need, thanks to the experiences of women like Mandy Daly.

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Irish Neonatal Health Alliance Winner of the 2017 European Foundation For The Care Of Newborn Infants (EFCNI)

‘Best Premature Baby Organisation’ INHA’s vision is to support and empower families affected by prematurity by advocating increased awareness, improved pre-conceptual, ante-natal and post-natal education, equitable and standardized neonatal care and improved long-term care for both the premature baby and the family. For further information, and to download our publications free of charge, please see www.inha.ie

INHA, 26 Oak Glen View, Southern Cross, Bray, Co. Wicklow, Ireland.

Telephone: 00 353 85 192 0602. Email: info@inha.ie

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The INHA is a registered charity under Section 39 of the Charities Act 2009. RCN20100100, CHY21984.

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AL L I N A DAY’S PL AY Working in childcare isn’t quite the 9 to 5 job you’d expect

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‘Your job is so easy—all you do is play!’ Right, let me stop you right there! Yes, it may seem part of my job is to play but that’s only a very small proportion of what my job comprises. Every day, I am not only a nursery nurse but: a baker; a cleaner, a waiter; an entertainer, a story teller, a naturalist; I am a nappy changer, a comforter, a peacemaker; a nurse, and a speech therapist— but most importantly, I am an educator. Working with early years is one of the most important jobs in the world for we are in fact inspiring the future, but unfortunately, all we will ever be to others are glorified babysitters.

Working with children has been my passion ever since I can remember: it’s all I can imagine myself doing. Quite honestly: deciding to work with early years children is the best decision I’ve ever made and it has shaped who I am. My heart and soul were not made to be cooped up in a cramped, uninspiring office—even the thought of that is nauseating. I have been working in childcare for five years and even though I’ve already experienced so much, it still feels as if I haven’t even scratched the surface. Every single day is different; you never really know what to expect and working with up to twelve toddlers really is a skill. I am the room leader of the toddler room in a private nursery in the heart of the Cotswolds and I love my job—I really, really do—I’ve worked hard to get to where I am today.

up-to-date: safeguarding and child protection, first aid, food hygiene, and British values to name a few. There are several hours spent unpaid at these training courses, usually provided to us at the weekend. We host mandatory parents’ evenings twice a year, which involve hours of our evenings spent discussing up to twenty different children’s development—unpaid. There are even some days where I don’t get a lunch break because I am required to be in ratio with the children. I go home worried sick about little Johnny’s sickness bug or little Timmy’s bump. I spend a lot of my time at home preparing resources for activities because there just isn’t the time to do so within work hours, and then—before I know it—it’s Monday again. There’s also a huge amount of paperwork involved in childcare. We write in learning journals, provide daily observations, yearly reports, two-year checks, ECAT (Every Child a Talker is a national project to develop language and communication) forms and individual planning. Then there’s the monthly planning, risk assessments, accident forms, health care forms, ongoing medicine forms and parental permission forms. We’re required to create monthly displays and topic boards but most importantly, we must ensure that our knowledge of the Early Years Foundation Stage is up to date in order for us to do all of the above. I can recite the seven areas of learning and the best activity to promote learning for each area in my sleep.

Toddlers are constantly learning: But working in childcare isn’t quite the 9 to 5 job numbers, letters, shapes, colours, you’d expect. Sure, we open at 8.00am and close at 5.30pm, but that’s only our opening hours— animals, manners, gross and fine-motor working hours for nursery nurses are extensive. skills, hygiene, empathy and emotions— that’s just the beginning. I spend copious time outside ‘work hours’ catching up, thinking about work or expanding my knowledge of childcare—in fact, I can’t We as educators have a duty of care to ensure remember the last time I read a book that was that learning is taking place every day. On fiction! It is paramount that my qualifications are top of the paperwork, we have to remember 45

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individual dietary requirements and allergies for each child, ensure children have produced birthday or anniversary cards for their families and remember which children have time limits on their sleep.

Then, there are the parents. There are times where working with parents is the

hardest part of the job.

I understand that everyone needs to work and earn a living, however, I cannot comprehend a parent’s anger and lack of concern when their child is required to leave nursery due to an illness. They bring their children into nursery knowing full well that they are poorly, sign in some Calpol and bobby off, leaving their usually happy-golucky child a sick, emotional wreck. When the inevitable time comes where we have to ring to tell parents to come and collect their sick child, 99 times out of 100, they argue and suggest they will sleep off their 38.9-degree temperature! There are parents who hand their children over, proudly announce that they’ve just soiled their nappy and possibly leaked all over their vest, and then proceed to stroll out the door because it’s no longer their problem. My personal pet peeve regards potty training. I’ve had parents express their desire for their child to start toilet training but also their own personal disinterest in guiding them through the process. The number of times I’ve had parents tell me that they’ve put their child back in a nappy because they were having too many accidents and they can’t deal with the washing is a disgrace. ‘I just don’t have the time or headspace to deal with potty training’ is an unfortunately common phrase. We often do our jobs and theirs.

or form, but that does not mean we aren’t family. I care very much about every single child that I look after. I watch them play, fight, learn and develop. I have seen them through all their moods: happy, sad, scared, angry, cheeky, stubborn and ill. I witness and support their achievements—they run and find me to tell me what they have done whether it be a wee on the potty, a painting of a purple monster or the discovery of a wriggly worm. I can understand their language and even translate it to their own parents. I am an expert in identifying many different types of comforters (no two dummies look the same to me). I am used to dealing with explosive nappies, wet pants and sickness bugs. I am exposed to all types of illnesses and infections, often without being able to take a sick day myself.

However, all the negatives are forgotten when you see the expression on a child’s face when they achieve what they believed they couldn’t. There’s no possible way to describe the sheer feeling of elation you experience when twelve toddlers shout your name in greeting. Experiencing a child’s logical argument that he can ‘just superglue it back on’ after being told to stop playing with his winky because it’ll fall off is nothing short of hilarious. Watching twelve toddlers copy the exaggerated dance you invented to demonstrate how bees fly is a mixture of joy and pride. Witnessing a child expecting a baby sister feed and stroke a dolly brings tears to your eyes. Children really are the wonders of the universe. These children are etched into my heart and I will love them and care about them no matter how old they become.

I struggled to decide which angle to write this We provide a warm, caring environment for article from; in the end I chose to be as honest as children to grow up in—we are essentially their possible. My job exposes me to both the sunshine second home. We’re not related in any way, shape and the rain; there are good parts and bad parts. 46

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Do the pros outweigh the cons? It’s debatable— They can help you see life from a different all I know is that the outcome of having a child perspective and it is very refreshing to relive bond with you is unlike any other. innocence, awe and imagination through the eyes of a toddler. But please, tell me again that I love working with children because although my job is easy! ■ it can be tough, it is an extremely rewarding job. Helping children develop, blossom and create Kerrie Mitchell-Ross their own personalities is a unique experience. 47

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M OTH E R H O OD BE HIN D T H E LE N S It’s the little things about motherhood that make my heart so happy and make me so excited when I capture them.

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Being a photographer has definitely influenced my own opinions on having a family. I’ve always loved children, but I never really gave much thought at all to having my own. The last couple of years spent running my business and getting to know so many different families has made me realise just how important it really is to me! It’s the little things about motherhood that make my heart so happy and make me so excited when I capture them.

Photos are also very special with siblings— that brand new bond! However, when you photograph newborns and siblings together, you definitely need a plan A, B and C and then about six extra back-up plans too!

I think some people worry how their children will react when a new baby comes along, but I can safely say that no matter what your worries are, when the new baby arrives, it always just works and you won’t know how it was ever any different. I specialise in documenting newborns, pregnancy, families and motherhood naturally and honestly. It’s difficult to comprehend how amazing our bodies are and how they’re capable of growing the tiny babies we love more than anything in this world. I’m totally in awe of the whole process.

Something I love about my job is when I get the opportunity to capture older siblings with their new brother or sister. I love seeing all the emotions, the proudest kind of love, the excitement and the sometimes not-sosubtle jealousy! They all react so differently and I find it fascinating. I also love playing a part in making them realise how great it is to be an older brother or sister and bringing out their excitement. When I photograph the new baby, I ask the children to help me as often as I can, even if it’s simply to hold the baby’s blanket in place or stroke the baby’s head to keep them calm and sleepy. I think giving them a part to play makes them realise how important they are.

I absolutely love what I do and I think it’s so important to capture children when they’re brand new as well as throughout their childhood. They change so quickly (even within two weeks you’ll see such a huge difference!) and as those first few weeks go by in a blur, you may not remember the smallest details. Your photos give you a chance to experience those memories over and over again, keeping them tiny forever! Whether you sit quietly with a box of prints, share them with friends and family, or hang one up in your home and talk about it with everyone who comes over, it’s a constant reminder to them of how much they’re loved, and to you of how amazing you are. Motherhood is really hard but I also think it’s incredible and so worth documenting, for yourself and for them. ■ Emily Hosken www.emilyhoskenphotography.com

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L ABO U R’S S N OW J OKE ‘Mummy, I’m calling her “snowflake” because she was born in the snow!’

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n Wednesday 28th February 2018 at around 4am, I started having faint contractions. At first, I wasn't sure if it was labour starting as my due date was 5th March, and l had been ten days late with my first daughter, so I was sure l was going to be late again. I started to time the contractions—they were coming and going now every ten minutes or so. I had to decide whether my husband, Jamie, should go to work or not, as he works an hour away and it had started to snow. I told him I was sure labour was starting and it was best not to go; I was so worried he'd get stuck in the snow as it was forecast to get heavier through the day.

The walk helped and my contractions were now four to five minutes apart. I called the hospital and they asked me to go in because of how intense it sounded when I was having a contraction.

I thought yes this is it, not much longer surely and I'll have had the baby! I arrived at the hospital at 7.30pm, but when I was examined I was told I was just 2cm dilated. I couldn't believe it! Because the weather was getting worse we were told to stay and go onto the ward. I was so frustrated by this point but as the midwife took us up to the ward, he told me to ignore the dilation number: I could be down in the labour ward in active labour in a few hours. He said you never know what will happen. I waited three hours in the ward— and reached 3cm dilation. My cervix was still posterior and I’d had enough—I just wanted to go home. I asked the midwife if it’d be ridiculous to go home but she said it was up to me and how I felt.

With my first daughter, my contractions started at the same time; by 1.30pm I was at the hospital, 7cm dilated and she was born at 7.36pm. Everyone told me the second will be quicker, so I thought great, I'll be at hospital by lunch time! By lunch time, my contractions were more painful but weren't any closer together. By 3pm, my contractions were still eight minutes apart. We decided to try and go for a walk. I had to be so careful as it had been snowing most of the day.

I was so uncomfortable and was getting more stressed being on the ward. I was worried this would slow the labour down, so we decided to go home. We left the hospital at 11pm: the snow was quite thick and it was -7 degrees. When

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we got home 45 minutes later, my contractions were still painfully intense so I decided on a bath to try and ease the pain. After half an hour of soaking, I felt a change—an urge to push. I figured I’d better get out of the bath! As I stood up, I started shaking uncontrollably and panicked. The contractions were coming thick and fast and the pain was unbearable; I could hardly walk from the shaking and felt faint as I tried to get dressed.

We needed to get back to the hospital. Jamie helped me down the stairs and into the car—the snow was getting thicker. As I called the labour ward to let them know we were returning, I was screaming in pain and— without realising it—was saying I needed to push! The midwife told us:

thankfully know very well!) brought out towels and blankets and told me everything would be okay: I just kept saying ‘I was only 3cm!’ I was constantly asking when the ambulance would arrive and felt the need to push. The operator stayed on the phone with us and said, ‘Alicia, if you need to push, then push.’ But I needed the ambulance: I couldn’t have a baby in a car! When I saw the flashing blue lights, the relief was unbelievable. The paramedics opened the door to me screaming ‘I need to push!’ I couldn’t wait any longer; the paramedic scrambled to his knees in the snow, leaned into the footwell of the car, and with one push, the head was born. At the next contraction, at 1.25am, my baby was born. Jamie cut the cord, the paramedics got us into the ambulance and took us to the hospital. I just kept looking at my new baby: I had just given birth in the front of the car!

‘Turn around, turn around! Go home and call an ambulance! You’re never going to make it to the hospital. Put the phone down and call an When we arrived back to the labour ward, the ambulance!’ midwife stopped in his tracks: ‘Where have Jamie turned the car around, we called for you been? I left you on the ward!’ an ambulance and made it home. The closest ‘Oh, well, I went home and had her in ambulance was dispatched and it would be 15 the car!’ minutes before it arrived: I was so frightened and in shock, but also in total denial that the We stayed overnight in the hospital and Jamie baby was coming. I was only 3cm not even came to collect us the next day with our two hours ago! The dispatch operator told me eldest daughter, Ava. ‘Mummy, I’m calling not to get out of the car—if I fainted in the her “snowflake” because she was born in the road, Jamie wouldn’t be able to get me in the snow!’ Sorry Ava, her name is Mila. ■ house. He told Jamie to see if the baby’s head Alicia Harris was there—it was. Jamie was told to go to the closest neighbour to get towels and blankets. I still couldn’t believe he was preparing us to have the baby, in the car, outside in the snow, in -7 degrees. My neighbour (who we

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WHE R E’S T H E M A LE PI LL? After all, it takes two to tango. Currently, the onus of contraception is shouldered primarily by women. Women feel the burden of being responsible for all precautions and suffer the consequences of both failing to prepare and preparing to succeed. Is this because there are scant options for men to control their fertility or because it’s a woman’s problem? After all, women have a reason to be concerned about unwanted pregnancy when the impact on their bodies and lives is far greater than that on their male partner. But all this assumes only single women and men are concerned about contraception; there are plenty of couples— married or not—looking to delay or prevent pregnancy altogether. Most investigations into men’s perceptions about their responsibility in contraception have targeted young, unmarried males; hardly a representative cohort.

indicates men with nonegalitarian beliefs think they have the dominant responsibility for contraception—so why hasn’t the medical and pharmaceutical industry caught up?

Worryingly, when it comes to contraception, women’s health is a secondary priority to costeffectiveness, with NHS guidelines noting cost-effectiveness as a reason for recommending implants, injections and IUDs.

The pill is perhaps the most common choice but hormonal contraceptives bring a host of issues: and no-one knows exactly what issues they’ll get until they try them. Each method lists a litany of side effects—weight gain, acne, mood swings, headaches, vaginitis, breast pain, cystitis, abdominal pain, prolonged bleeding, etc.—and There’s evidence to suggest a man is less likely there’s no research into the long-term effects to take responsibility for effective contraception of spending your fertile years full of synthetic if he lacks a sense of obligation for the children hormones. that may result. Married men who hold more egalitarian attitudes are more likely to think And what of the fact these methods are never 100 men and women have a shared responsibility percent effective? When used correctly, they get for contraception. Furthermore, research extremely close, but perfect use is a pipedream shows men’s involvement in decisions about and not a reality for most women. Life gets in the sex, contraception and childrearing strongly way. Not only do you need to suffer the potential influences sexual and contraceptive behaviour, side effects, but it could all be for naught in the significantly strengthens and reduces discord end anyway. Related to this is the assumption in relationships, and reinforces a man’s that contraceptive responsibility purely requires responsibility for the children he fathers. using contraception: what about the cost and Interestingly however, the same research time spent attending appointments? 54

The lack of advancement in male forms of reversible contraception has received significant academic attention and yet we still lack realistic developments. Of the current methods, one is permanent (vasectomy), two involve not having sex (abstinence and outercourse) and one should not be considered effective (withdrawal).

Men need choices too. In theory, a male contraceptive could be easily developed: it’s not like we don’t understand the biology of sperm production. In one 2016 study, men were injected with testosterone and progestogen—similar to the hormones in the female pill—and pregnancy rates were lower than typically seen for women on the pill. Promising stuff! But the study had to be cut short: the men were experiencing negative side effects including acne, mood disorders and raised libido. This seems the most jarring part of this discussion: why should men get a pass on the standard side effects experienced by women the world over? There’s more to it: 75 percent of the study participants wanted to continue. One of the independent committees overseeing the safety of the trial pulled the plug.

the female pill is the third most-used form of contraception, with a projected market value of nearly $23 billion by 2023. There’s little incentive for pharmaceutical companies to invest in a male pill. It’s not just the billions of dollars required to bring a new drug to market, medical regulators don’t view a male contraceptive as worth the risk: an unwanted pregnancy does not pose the same risks to men as it would to women, so investment in this area isn’t seen as viable.

Given the socio-historical context in which female contraception emerged and the very real fact that contraception has empowered women by allowing greater control over family planning, it made sense for women to take responsibility for preventing pregnancy. But we’ve moved on from the sexual liberation early days. Research shows most men perceive a couple’s decision-making regarding sexual behaviour and contraception as an egalitarian process: 78 percent of men in a heterosexual relationship view decisions about contraception as a shared responsibility. Personal attitudes and perceptions shape contraceptive opinions and decisions, and communication between partners is key to ensuring effective contraception in each situation. That current methods tend to exclude men from the As always, there’s a money aspect too. Globally, conversation is both unjust and unwise. ■ 55

WHY I D ON’T WANT KI D S It’s got nothing to do with selfishness or not liking children.

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t’s not my independent streak manifesting in a stubborn phase; I wouldn’t think differently if they were my own; I won’t one day realise what I’ve been missing. It’s not an understandable stance right now because life is still tumultuous and I’m still young and there’s plenty of time for that. It’s not a feminist stand against traditional family roles, it’s not a lack of money or security, it’s not because I’d rather spend that money on holidays or fancy clothes. It’s not an environmental concern because our planet is already seriously overpopulated and with many unwanted kids at that. It’s not because I don’t like children (I’m just not great with them) and it’s not because I think I’d be a bad parent. I’m not worried about passing on any out-of-whack genetics (my family line made it this far, after all!) and I’m not worried they’d turn out to be serial killers or axe-murderers. As gory and scary as the birth horror stories can be, and how much the thought of my body changing during pregnancy squicks me out, that’s not what’s put me off having kids.

It’s not even everything that comes after—although that certainly doesn’t help. The utter exhaustion—the sleep-deprived, zombie existence as your entire world boils down to keeping a bundle of bodily fluids 56

and ear-splitting shrieks alive. The endless responsibility, the eternal worry—oh yeah, like I’d be able to stop worrying about them once they turned 18 and wandered off into the big wide world to make all the same mistakes I did. Being the sole caretaker to small children day in and day out; so tired it feels this level of exhaustion is my new permanent state of being; carrying the constant guilt and doubt surrounding my actions and choices in raising children; possibly regretting the whole thing. All this can be added to the mix when I think about it, but it’s not even because I’m selfish— very much so.

hand them to me and I’d feel nothing. I’m scared that would never go away, and instead of a burning desire to care for and give this child everything, I’d go through the necessary motions, raising them properly but unable to give them what they really need: love with no strings attached.

This revelation tends to shock and horrify people who go to great lengths to convince me otherwise: psychology professor Leslie Ashburn-Nardo wrote, ‘people experience moral outrage when they perceive someone has violated a morally prescribed behaviour, something we’re “supposed to do” because I know exactly why I don’t want kids: it’s what we see as right.’ I don’t owe the I don’t want to find out how it feels to world anything, and I don’t owe it kids. resent a child for keeping me from the But more than this: every child deserves to life I wanted to live. be loved unconditionally, completely and unequivocally. Every child deserves to know I don’t want to resent my husband (who thinks they are loved and to feel loved—and I’m he wants kids) and I can’t bear the thought of scared mine wouldn’t. burdening my child with the suspicion they’re unwanted—or unloved. I would love my You can tell me that’s silly; you can tell me I’m children; I would love them with everything too nice a person for that to happen; you can I had, but the lifestyle that accompanies tell me the joy that comes with having children this love is not the one I want. Children are more than offsets giving up whatever you feel perceptive—you can’t tell me they wouldn’t be you’re giving up. But once you take the leap, able to sense an undercurrent of resentment I that’s it—there’s no handing a child back if it’s would desperately try to keep buried. not okay. I’m scared of post-natal depression in a That’s simply too great a risk for me. ■ girl already battling perfectly-normal-nothormone-influenced depression; I’m scared of Jade Sterling not bonding with my child. I’m scared they’d

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D I G I TA L CONTR AC E P T I ON IS CO M I N G You can trust your smartphone to prevent a pregnancy— not now, but soon.

The much-hyped digital contraceptive app, Natural Cycles, has come under fire this summer. Mounting controversy surrounds its claims and its advertising, but the US Food and Drug Administration have approved it as a form of contraception, following similar approval by the European Union. After all, women have been doing this without technology for millennia. Fertility tracking is an excellent way to avoid pregnancy without artificial hormones flooding

your body—abstain from sex or use protection when you’re ovulating. Simple. Except, there’s no way of predicting ovulation with 100 percent accuracy. Menstrual cycles are fickle beasts involving multiple hormones that are affected by myriad outside influences, including stress levels and body fat percentages. Cycles are rarely consistent; simply tracking 28 days from the start

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of your last period is not enough to accurately predict anything. You can use other data including your levels of luteinising hormone, the thickness of your cervical mucous, and daily basal temperature—which is what Natural Cycles tracks—but these are all subject to human fallibility. The strips to test your urine for the luteinising hormone must be used first thing in the morning and even if you manage that every day, you need to understand fertility and ovulation occur at separate times. Your fertile window is four to five days before ovulation, while the test strips signal when ovulation is roughly 24 hours away; a negative indicator on the strip four to five days before you expect it is not the go-ahead to have unprotected sex. So you need to test your urine at the same time every morning (sayonara weekend liein)—the same time at which you’re supposed to take your oral temperature for the Natural Cycles app. Logging this every day allows the app to learn the patterns for your ovulation cycle as ovulation causes a slight rise in basal body temperature, which is most accurate first thing in the morning—unless you didn’t sleep very well, have an infection, have a hangover, feel stressed, or got up in the middle of the night to get a glass of water. It can even be affected by how many hours of sleep you got, and Natural Cycles does recommend against logging your temperature over the weekend—this raises two questions.

How can you get a 93 percent accuracy rate for your temperature changes over time, and what if you don’t have that kind of stability in your life? Every form of contraception has an ‘ideal’ user; those on the contraceptive pill need to be regimented about taking their pill at the same time every day, while those with the implant are more suited to a ‘put it in and forget about it’ 59

approach. For the Natural Cycles app, you need to be regimented at taking your temperature every day, with a very stable lifestyle—and you need to want to have children. What’s the definition of contraception again? The founders of the app describe their ideal user as a woman who is planning to have children at some point, and would like a break from hormonal contraception before trying, saying it’s not a good option for women who want to entirely avoid pregnancy. This is not the message that comes across in Natural Cycles’ marketing. But this is not an article condemning the failings of an app; it’s not an article about the difficulties faced by women around the world simply trying to have sex and not get pregnant. Rather, let’s look to the future; what could make a calendarbased, non-hormonal contraceptive effective for every woman?

The Natural Cycles app is a great start. Female health technology is booming with an estimated $1 billion of investment raised worldwide in the last three years. Hormone-free, non-invasive and easy to use— it’s definitely on the right track. The app does the work for you, handling all the data and the calculations, which may be where normal women slip up when tracking their fertility on a traditional calendar. And that’s the catch—being normal. The average woman looking to avoid pregnancy is not the woman targeted by Natural Cycles. Who has the level of stability assumed by the app’s creators? Who isn’t stressed sometimes (or all the time); who doesn’t get sick every now and again; who doesn’t drink one, two, or three too many on occasion? Who manages to charge their phone every night without fail and who hasn’t misplaced something? You need to keep that thermometer on your bedside table and reach for it immediately upon waking—move

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even the slightest bit (say, going in search of a thermometer you could have sworn you’d left there the day before), and your accuracy rate will drop. And on that note, who sleeps exactly the same amount every night? The average woman is not going to achieve the 93 percent accuracy rate Natural Cycles touts—she’s more likely to get the 76 percent rate seen with normal calendar planning. Even then, Natural Cycles doesn’t protect you from pregnancy. It can only tell you when you’re at risk of getting pregnant—if anything, it works best as an alarm bell for condom sales. At the moment, that’s the best way to use digital contraception; if you lack the discipline needed, let the app warn you when you need to use additional protection. It’s better than using condoms all the time, or adding artificial hormones to your body if that’s what you’re trying to avoid.

We’re standing on the precipice of a revolution in healthcare. Personalised approaches to health are the future, and they’re just around the corner. Nonhormonal contraception is being digitised with great potential. Consider the efficacy we could achieve if we had an easier way of measuring

temperature every morning, at exactly the same time; or the levels of luteinising hormones circulating in our body at any moment; or even the split second an egg is released. There are some more invasive solutions to the tracking dilemmas; could an implant be used, not to release hormones into the blood stream, but to measure and transmit data to a smartphone? Could something similar sit unobtrusively in a fallopian tube and signal when an egg passes it by? Could a chip live under the tongue and take note of our basal temperature every morning at 6am without us having to do a single thing? Diabetes sufferers are experiencing a similar boom in the technology available to them. Rather than pricking their fingers to measure blood sugar levels, small sensor patches can be worn on the arm to measure glucose levels in the interstitial fluid between the cells under the skin. The measurements aren’t as accurate, true, but patients can monitor their levels continuously and wirelessly with a tap of their phone. Eversense is a subcutaneous implant that measures glucose and transmits data in real time—and also now has FDA approval. Similar technology for female contraception is hardly beyond the realms of possibility. ■

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B E IN G A WO M A N OF A CE RTA I N AGE All aboard the menopause express.

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hat age being fifty. The truth is, I arrived here sooner than I expected. To mark the occasion (and to make matters worse), people sent cards congratulating me on reaching a milestone age; other cards simply sympathised with me achieving the Big 50.

eyes and nod their heads in sympathy. Ireland in the eighties was a place where ‘ladies’ problems’ were talked about in hushed tones.

I had just about accepted the whole ageing process—I was, after all, still managing to read my text messages using a selfiestick, only after I ‘It’s all downhill from here.’ ‘Let the sagging discovered my arms were no longer long enough. commence.’ ‘Welcome to the OAP club.’ ‘Age is just a number. A BIG ONE.’ The truth is My body was changing at a rate of knots; if everyone thought they were hilarious, and some you’re easily offended or squeamish, look away now. of the cards were. To shift my thoughts to more pressing matters, my particular favourite card: The first thing to go is the neck: it looked like it ‘All aboard the menopause express’ needed a good ironing. No matter how high I held my head, I still had this wrinkled neck. I had At this terrifying prospect, I thought about two options—surgery or turtle necks and I now getting a black shift dress and boxy hat—a bit own the entire range of turtle necks by Zara. My like Jackie O—and weeping into a black lace waist disappeared, gone overnight. I still haven’t handkerchief. But I had no time for all that: I been able to find it, or regain it for that matter. was already on the menopause express heading south and I’d no idea when the journey would My boobs took on a life of their own. They end or even what state I’d be in when I got there. grew rapidly and spilled out over my 34Bs and wobbled like jelly as I moved. I couldn’t wait to I’m not an uneducated or unintelligent woman get home in the evening so I could release them but was totally naive about the symptoms from their captors. It was such a relief to set them menopause would unleash upon me. It was a free—they were like confined animals and raced journey I knew I’d be making but not one I’d one another to my waist upon their release. prepared for. My mother had gone through ‘The Change’ in the eighties and never spoke to us The truth is, I’m not a woman who is at ease about it. Occasionally she’d whisper the words with her own body; I don’t walk around naked ‘The Change’ to her sisters and they’d all roll their or even half naked—never did—so for no other 62

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reason other than a slight moment of insanity, I rested just up from my waist and either side of decided it was time to see my changing body. my protruding belly button and my Buddha belly rested on top of my ‘comfy cotton’ knickers, So I did. I stripped, well except for my drawers: forming a sort of grin. I’m actually not that brave. I tiptoed to the mirror with my face scrunched up and my eyes closed This was too much for a woman to take in one as tightly as they could. I stood breathing deeply, afternoon. I needed to lie down. No, I didn’t: I still too bloody scared to open my eyes. needed a xanax or a plastic surgeon, or both.

Minutes passed. Well, maybe twenty seconds. I did it. I opened my eyes. This was my first mistake. There staring back at me was my torso looking like a slightly deformed. slightly geriatric, bald, cross-eyed bloke. It’s true: my nipples

As Mother Nature was not about to make me an exception to the ageing process, I had to accept my changing menopausal body. I decided my only course of action was to do something about it myself. A little self help would go a long way as I wasn’t yet prepared for hormone replacement therapy (HRT) or any kind of intervention.

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Yoga. That’s what I decided on so I signed up for a local yoga class for ‘mature women’. Oddly, I’d never considered myself mature before in either years or nature but I qualified for the mature yoga class.

As for weight gain, I knew I’d get a little thicker around my waist but I had no idea my boobs would go to a DD. I haul them around with me and occasionally dress them up, but the truth is they operate independently of me and independently of one another for that matter. Buy the right size bra and stretchy jeans— you’ll I needed to wait for my period to pass—now the look thinner and be a lot more comfortable in thing about periods is, they don’t just stop, oh clothes that fit and move with you. no, they like to go out with bang. Periods often don’t make an appearance for three, four, even Flatulence is one that I did not expect at all. It’s five months and then one morning you wake up, loud and abrasive and it too sneaks up on you so shocked at the sight of blood you’re convinced and frightens the absolute bejesus out of you there’s a dead horse’s head in the bed. Mine got and people around you. I don’t have a solution if so heavy that the pads I wore were so large they you’re already in the midst of menopause, but if would make a shuffling sound like a child’s nappy you’re not, do your pelvic floor exercises. I forgot as I walked. I would try to walk slowly simply to to do mine and now I’m sorry. reduce the ‘nappy noise’—yeah that failed too, I had to accept that this was a noisy period in my Mood swings were something else I hadn’t life. expected to be quite so bad, but they really can be. My advice is not to be too hard on yourself. I’m going to leave you with some words of HRT seemed to combat this for me; my family wisdom on how to cope with menopause. It’s have written a thank you letter to ‘them lovely like anything in life you need to prepare and you hormone’ people. need to be made aware of the symptoms.

Being menopausal is not the end of the world: as my mother whispered to her sisters, it’s ‘The Change’. Everything changes, your body, your attitude and above all, your boobs.

Hot flushes or flashes: yes they are so very unpleasant. Always keep deodorant and baby wipes with you. They strike when you least expect them to and with such force you’ll find yourself stripping. I use panty liners inside my I would love people to talk about it more; I have shirts under my armpits. been with women who refuse to mention it even Your hair gets thinner everywhere except on in passing. So, my solution was to get myself your upper lip and chin where it goes feral. a meno crew. We spend hours sweating and bitching, sometimes even laughing. But tell no Always have a pair of tweezers with you. one: that’s just between us. ■ Aches and pains in your joints—I didn’t expect this at all. My doctor prescribed HRT to combat Denise Smith it, which worked. Now, I no longer move in slow motion or make groaning sounds when I get up www.thejoyofmenopausemyarseblog.live off the sofa.

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LOOKIN G A F TE R YO U R GYN A ECOLOG I CA L HE A LT H 7 ways to ensure your down there is in tip top shape Know what’s normal

small ulcer or something that’s bleeding on your vulva, make an appointment with your doctor. It’s a rare cancer but seeking advice if anything goes a little weird down there is a good habit to get into.

This means what’s normal for you. Get to know your body—inside and out—and see your doctor about any unusual bleeding, discharge, bloating, pelvic pain, weight loss, fatigue or change in bowel habits. Besides, research shows the more comfortable you Opt for cotton are with the way your genitals look, feel and When it comes to your underwear, your smell, the more sexually satisfied you’ll be. vagina wants cotton—that’s why most knickers come with a strip of cotton in the crotch. Cotton lets air in and absorbs any Chill out Dr Xiaobin Wang at the Children’s Memorial moisture, letting your lady parts breathe the Hospital in Chicago found stressed-out way they need to. women are twice as likely to suffer period pain, possibly because stress increases the Skip the scented soaps production of prostaglandins which trigger To keep things clean down there, you cramps. really only need to rinse with warm water and maybe a plain, gentle, unscented soap. Anything with scents or chemicals will be Stop smoking Beyond all the issues smoking can cause in too drying on the sensitive skin otherwise. your lungs and heart, it also increases your risk of cervical cancer. Smoking has a direct Kegels all day effect on the immune system of the cervix Kegel exercises aren’t just for postpartum and women who smoke are less able to get women; they help strengthen your pelvic rid of a Human Papilloma Virus infection, floor muscles, which then reduces strain on the virus which causes cervical cancer. your pelvic organs and improves bladder and bowel function. Try three sets of 10 kegels each day—tighten your pelvic floor muscles Go to the doctor We can’t stress this enough. A third of (the ones you squeeze to stop urination) and women with vulval cancer are diagnosed late then hold them tight for five seconds. Release because they’re too embarrassed to go to the and repeat. doctor. If you’ve got a weird itch or sore spot, 66

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