Category Archives: Mother’s Health

New beginnings

New beginnings hold so much potential. Image source: Wikimedia Commons, uploaded by Karora.

New beginnings hold so much potential. Image source: Wikimedia Commons, uploaded by Karora.

An unintended and prolonged absence has occurred and like missing anyone you’re fond of, I’ve definitely missed my blog. Life for many of us seems to have a somewhat annoying habit of getting in the way of what we perceive as far better plans. In fact so often I have to resort to my Antarctic fieldwork or alternatively laboratory science motto “Anything that can go wrong will go wrong”.  Parents will relate to this concept as well because in the past tense, it can frequently be a summation sentence of a pretty ordinary day.

This first blog under the new title of Parenting by Instinct should be a joyous blog full of the celebration of a new beginning- like new growth occurring, the chance to celebrate a new season, the slight nerves mixed with excitement of doing something for the first time.

I should be using this first PbI blog post to discuss any number of new pieces of science that parents should know about – such as a recent study that showed that even small lies from adults to children may result in the child then becoming more dishonest (and I wrote an article on it here). Or another study showing that the gut microbe make-up doesn’t settle for up until the first three years of life and this has implications for breastfeeding duration.

I will write about these eventually but in the meantime for the last couple of months my world has been somewhat rocked. It seems incredibly ironic that my last post was about Embracing Change and as it turns out just a few days before change was so forcibly on top of me.

I wrote in that post about this kind of change and even the effect it is having in my city: “Change that’s not driven by internal ruminations and is instead imposed on us is frightening and the change and associated stress that my home town people are experiencing is leading to a new vulnerable spanning my age group.”

The university where I work has been under financial stress for many reasons, not the least of which have been multi-faceted earthquake related effects. These have had sustained and considerable impacts on the staff that work there. Exhausted after a very intense year of restructuring all of our undergraduate qualifications (on top of more direct earthquake effects) and aware that the ‘change proposals’ were being announced across Faculties, it was a strange combination of complete surprise and yet non surprise to find a letter on my desk telling me that there were impacts on my position from these proposals.

Twenty-four hours later in a meeting with my Dean, supported by my mother at her request and where the room seemed to come in and out of focus, I got to hear that they propose to disestablish my position. With some 15% of academic staff in our Faculty proposed to go, 10% of staff overall and potentially as an unintended outcome 42% of women academics these are big changes on the cards.

These last nine weeks have flown by in a roller-coaster blur. Confronting me at every moment of the day is the prospect of phenomenal change in the supposedly secure world of tenured academia. It’s been a long time, these two months, spent drifting in limbo land, working through the stages of grief for the existence I immediately exited the second I saw that ominous envelope.

I’ve never experienced feelings of stress on this level before and it doesn’t seem in keeping with my character, except that this particular stressor is sitting now on layers of significant stress from new parenthood, and many, many direct and indirect earthquake effects, all building up over several years like compound interest. Others in my city can no doubt relate to this.

It’s given me a sensitive stomach and the low point perhaps was eating the tiniest bit of a pretty average meat pie my daughter had been eating en route out of town last week, which within seconds had me violently throwing up all over myself in the car- I was even slightly more contained than that when pregnant with nine months of debilitating morning sickness. What followed was an unintended, uncomfortable and unpleasant drive home to get changed and clean the car before setting off again. Driving past the offending bakery today brought back the association and history nearly repeated. My daughter said “Oh poor Mummy, even driving past the bakery makes you nearly throw up”! It’s good at least that we can laugh about it and she has been developing fantastic empathy skills, frequently doing all manner of nice things for me because “Mummy’s lost her job” (although I haven’t yet).

Mental space has been filled with trying to find the strength to mount a response to maintain my position in some form and at the same time to think what else the future might hold. Is this an opportunity for change that may indeed be a welcome visitor, that might propel my life in a different direction? I’m not entirely ready for that aspect- too exhausted surviving the now, but it’s always in the back of my mind- possibilities being considered and ideas formulating.

Many people, far too many, go through the prospect of redundancy as I am. In my situation, my job is nothing close to a job- it’s far more of a vocation, a considerable part of my identity. Being a scientist is something that is intrinsically a part of me, inescapably part of my fabric.

So too, is being a mother. And throughout this beyond-stressful experience as I wait to know my fate and having  temporarily re-found my calmer state, I’ve been thinking about whether there are similarities of this experience to an aspect of parenthood,

In many ways, it’s a little like adjusting to life as a parent. One striking difference is that in general the birth of a child is a wanted event, whereas the prospect of loss of a job tends not to be. However, both situations are full of difficult, challenging surprises. Both involve going through a form of grief, or they should do.

Becoming a parent is a huge adjustment, especially in the modern world, where there isn’t typically extended family existence. At the same time as celebrating the new life you have created, ever so gradually finding your mothering or fathering rhythm, and finding the pure pleasure of moments spent gazing at the miracles of daily development, there is, or there should be, some level of grief to deal with the life you left behind.

And to fully engage in the parenting space, it’s essential that this process of mourning occurs. It may not even be registered consciously and I would hope for most parents it wouldn’t resemble anything of the grief I’ve felt with respect to my job these last weeks.

Some parents however, don’t complete their mourning journey, think their child must squeeze itself into their life that should largely carry on as before, but this places them stuck in the denial phase of grief unable to fully commit themselves to embracing the change that is in front of them.

Falling completely into parenthood doesn’t mean that all of one’s former life is lost though, nor one’s identify and nor should it- there’s no such thing as a complete life switch- rather life is a jigsaw puzzle at times, and bits fit in and out as required. It’s more fluid than that too- who we are today is different to who we were yesterday and who we will be tomorrow. Our environment and circumstances are constantly moulding us.

For me in the last few weeks, more than at any other time in my life, I’ve needed to find some space for myself and to engage in some self-care. I’ve had to continue to turn up at work, to honour teaching commitments, supervision of students, attend meetings and of course continue to be a mother.

With so much pressure ,self-care has been a necessity. This is important for mothers and fathers too. However, I think the societal pressures that seem to dictate that me-time needs such high elevation of status in the forms it is often promoted it should take are not always what is required. Self-care and me-time can be simple and it doesn’t even need to be without children; at least not in my book, as it seldom is child-free (see more here in The rubberband effect: building and maintaining resilience).

A cafe trip for a hot chocolate, time spent in the library slowly choosing books, gym and yoga time, a few minutes a day of meditation/breathing, the joy of cooking a lovely meal, watching a movie or a favourite programme, an afternoon snooze, an early night, gardening, a catch up with friends with or without kids all rate high for me.

But the most restorative thing is getting up high- driving to the mountains or more easily climbing up the hills in my city. There’s something that feels fantastic about working hard and then being on top of something, seeing a vista that is grand and sweeping- all the way from mountains to sea and over the city, connecting yourself back to home. It’s a form of conquering and feeling a profound sense of vitality, of connecting with the primal urge to be at one with nature and also of getting away from it all. I always do these trips with MissBB but a few weeks ago and early on in this potential job loss situation, she was in childcare and for the first time in her existence I was having a de-stress day at home without her.

Working hard to get up high on the hills is incredibly restorative

Working hard to get up high on the hills is incredibly restorative

So I walked up the hills on my own and strangely it felt so difficult. I had no one to carry as I usually do and so I should have bounced up, but without the distraction of four-year old chatter I was left to concentrate on the steepness, the deep breathing, and my own thoughts about the future and it was hard. As much though as it was challenging I really felt a sense of achievement and it did give me precious time to reflect. I missed my girl though, and all I really wanted at the top was a hug from her. My life is enriched by her presence and I see no real need to miss out on that. At the end of the day we’re social animals.

At work my existence for these weeks has largely been filled in a sense socially as well- lots of intense discussions about my situation, albeit from concerned colleagues, but those same conversations have sucked the life force out of me, leaving me feeling an emotional exhaustion that even beats the newborn phase.

Sadly, I’ve also experienced colleagues treating me like I have a communicable disease: I’ve had doors shutting on me, people walking away and not talking to me- them being afraid of what to say, worried I’ll burst into tears on them. There was also a truly demoralising on an other-worldly level departmental meeting that ultimately saw me exiting but I teetered on giving an impassioned speech before deciding I would tackle inaction and apathy another way. And in the end it worked: the submissions to support me and the proposition I have put forward have been really amazing, and touching.

How many parents out there can relate to these same kinds of experiences in their role as mums or dads? Feeling isolated, shunned perhaps for many reasons, and when people know you’re having a hard time choosing to be absent rather than supportive? Or in contrast some truly devastating conversations that lead you wondering whether these people know the harm they are causing with their ill-chosen words, or missing words?

When we become parents we’re frequently accosted by offers of support and advice and it can be exhausting to listen to all this babble and to know what to do with it. So much depends though on the attitude that we bring to listening. People come to these discussions believe-it-or-not usually from a  place of caring and as much as it can be shattering and bewildering, sometimes it’s good to take on board what’s said and see how it fits. Stick up for yourself if you truly need to. But know too that in the process, listening can help you shape your own story and your own values, even if you disagree with what’s said. I’ve certainly found the discussions with colleagues helpful at work, as tiring as they have been, because they’ve let me work through my story and my plans and given me valuable outside perspective.

We’re used also  when adversity strikes (again) to hearing the supposedly reassuring “What doesn’t kill you makes you stronger”. This is indeed true to a point but to be fair I think there’s a limit.  There’s only a certain number of challenges before I feel the character cup is pretty much overflowing and I think that many of us, including myself, that live in this earthquake-ravaged city have had a truly disproportionate number of adverse situations to face in the last few years. As an educator however, I know in reality we are always learning but it sure is hard to stomach that concept sometimes, literally!

In amongst all this challenge there was a day of pure fabulous-ness and a reminder that even in dark days that there will always be moments of total sunshine, especially if you work hard to create them. For us it was a day of chasing the Royals. Here’s a teaser picture. More on that in the next post.

Royal interlude- Duchess Catherine creates happy moments

Royal interlude- Duchess Catherine creates happy moments

As I wait to hear about my job, I’ve been reflecting about what I want my life mission to be. When I reached the top of the gondola on my walk, I met a young woman who had taken the gondola up and who was incredibly impressed I had walked up all that way. She told me that I, a complete stranger, inspired her. It was incredibly touching. She didn’t need to go out of her way to talk to me and more than that nor did she need to offer that personal piece of herself. What she gave me was a precious gift- of words. Words are easy to throw out of our mouths- but words that make a positive difference in other’s lives – they’re treasure.

What I want really is pretty simple: to inspire and to be inspired. I achieved both that day on the hills. Being a mother to a fabulous four year old too, who views me as her greatest role model and in turn inspires me every day, is a pretty good step in the right direction, whatever ‘job’ I end up doing.

Time to contemplate up the top.

Time to contemplate up the top.


The place between: responding to your child’s distress gives everyone space to learn

photo 1 A couple of days ago I was struck by a revelation. Like the situation for many key learning lessons, it initially didn’t appear as a very auspicious day. In fact it was anything but. I was to be honest feeling hideous and worse than that, feeling hideous at work with blocked sinuses and vertigo, a super foggy brain that would not properly activate to the tasks required of me, a still malfunctioning computer and a strong desire to be in bed.

I had also mistakenly written down a meeting time an hour later than it was in my diary and when I received a polite Tweeted prompt from the meeting head (luckily just a journal article discussion club but one on an article I had provided and was meant to be discussing) I took off running across campus via the car park to get to the target building. Slightly distracted as I passed some IT staff (thinking about my problem computer), jumping over some borders at the same time, and not noticing the purely ornamental, annoyingly always undoing shoelace on my shoe had done just that and got stuck under my other shoe, I suddenly went flying through the air and smacked into rough tarmac at significant force on hands, knees and the front of my feet.

Hearing an “Are you all right Victoria?” from the IT staff I popped back up to crouch position, and realised that while I might be injured I was actually all right and I had a meeting to get to so I yelled back “I’m fine”. At this point though I kind of took stock and realised that 1) my right hand was missing a significant amount of skin on the palm; 2) I had really hurt my right knee and it was full of holes, and my left knee was similar; 3) I had grazes all over my feet and 4) causing the most distress was that my near new capri pants were literally shredded from the fall. I was relieved my new phone and well beaten up sunglasses had survived- priorities! Despite all that I was relatively calm. I managed to Tweet back en route that they needed to have the first aid kit ready.

I pretty much walked in the door of the meeting looking like a crazed lunatic, bleeding and probably looked a bit shocked. After all grown ups don’t typically fall over and come to grief. First aid was kindly administered and I carried on. Straight after my meeting I went to visit MissBB at childcare and asked her for all I wanted- a cuddle, which instantly made me feel better. Of course everyone I saw for the rest of the day asked me what had happened and I got a lot of “Oh how embarrassing” or “You must feel really silly” comments.

Not one to be deterred by injuries I went to yoga after work, where I discovered that approximately 88.8% of the moves were manageable, although not necessarily painless. It was here that my revelation happened. Lying down for the mindful meditative finale of the class, where I was meant to be clearing my mind suddenly I realised that despite feeling unwell I had actually demonstrated great resilience today. More than that my mind alerted myself to the fact that I could have been really embarrassed at what had happened but I wasn’t. I could have felt ashamed, berated myself for being so stupid, felt really sorry for myself, I could have cried (that would have been perfectly understandable), but I didn’t. I just accepted what had happened and moved on. I was struck by how powerful that felt, not to allow myself to wallow in negative thoughts in a way that society (clearly some of my colleagues) maybe expected me to act. It was a reminder that from challenge comes personal growth and that the mind when given the right conditions can flourish and grow with positive thoughts.

And there in my mindfulness practice I felt an incredible sense of peace and happiness. Even more so because I was struck by if I could get to this place at age 40, how amazing it could be to teach my daughter at age 4. Then I realised that she probably has this sorted already- children are at least 10x* more onto it than we frequently give them credit.

photo 3

Most of the time our children when they hurt themselves, or are indeed upset about something (whether we think their tears are rational or reasonable to us or not), just need our support and acknowledgement to get through their pain and/or distress. In other words, they need our emotional responsiveness towards them in that moment. We adults, when distressed may be able to administer our own response to suffice, as I did to myself, due to our much better ability to regulate our emotional state. A hug from someone else we care about though can be all it takes to feel all right again.

How we respond to our children in this moment (and there’s another blog post on this coming very soon regarding social media) can be a valuable learning tool and has longer term implications. My experience reminded me of an excellent recent post on Evolutionary Parenting I had recently read on Distraction, Redirection and Responsiveness.

Personally I’ve never been comfortable with distraction as a parenting strategy- it has always felt a little dishonest on my shoulders. Distraction is where we try to get a child/baby to stop crying or doing something by showing them something else. A child is for example really upset about their mother leaving them at childcare and so they get shown a ball, when all they want is their mum or at least someone to talk about that they want their mum. Redirection is a useful technique for some situations. This is typically used for misbehaving rather than upset children and is where you move a child’s undesirable behaviour to more desirable behaviour but with explanations of why, e.g tipping flour over the floor shifted to baking something together.

However, it is in the fostering of good attachment through responsiveness that I have been focusing my efforts as this has been clearly shown[1] to be associated with positive outcomes. Responsiveness is when you acknowledge and respond to the child’s distress/communication through respect for the child’s feelings. It doesn’t mean you necessarily give into your child and you can still maintain your boundaries (See Boundaries, fencing and reliving childhood). It frequently involves staying with the child and hugging them until they are calm enough to look at other ways to express themselves and discuss other coping strategies etc. Responsiveness when a child is not distressed is equally important too in terms of setting up ‘at ease’ communication patterns as children age.

Like any parent I have my moments where I don’t comply with my own plan. A few months ago I was aware that MissBB was reaching a more challenging stage and I noticed that my parenting efforts were starting to frequently be the result of letting my cultural filters slip back into place, which wasn’t aiding myself or my daughter. Since getting back to my own parenting values (See Boundaries, fencing and reliving childhood), with a central tenet of strong positive attachment including responsiveness, I have noticed a profound and positive difference in her behaviour. It’s a sample size of only one, but a good example that a form of “Are you all right?”  (and come and have a hug until you are) works incredibly well.

Given though, that children are frequently one step ahead, I decided to ask MissBB how she would like to be treated. I presented a scenario of having hurt herself and then outlined in the most unbiased language I could- distraction, redirection and responsiveness options. It’s just a sample size of one again and a single scenario of distress but she immediately said that she would want the responsiveness option. When I asked her why she said “because I just like hugs, lots of hugs”.  She also added that when she’s having trouble calming down she looks around her to feel ok- this is one of the strategies we have worked out together (you can read more about that in Boundaries, fencing and reliving childhood and The rubberband effect: building and maintaining resilience)

That, and our mindfulness breathing approaches we successfully use. Responding to our children this way AND to ourselves is an empowering and positive approach for all parties. It’s a little bit like creating “The Place Between” – “The place where MAGIC sends you“**. In other words, providing a supported, calming and safe place until you or your child is emotionally ready to talk about their distress and work through it.

It takes enormous personal strength to grow as a person, to examine within and to find a better way, especially if that means not giving in to the expectations of those around you. It takes an equivalent amount of strength and the same principles to find the parent within, the one that deep inside you discover you want to be. At every step it may be a battle against the voices of those around you and all the filters that you’ve accumulated over your life that want to keep popping back into place. But when you can stand up and say to yourself “I’m all right”, acknowledging hurt you may have experienced but learning and moving on, then that’s a moment to cherish. I encourage everyone to embark on this journey.

And for our children, who are little but oh so very important people too, there’s no better time for them to start this journey than right now, with a parent or caregiver that can demonstrate their respect to their child’s attempt to communicate. It may feel like the hardest thing in the world sometimes to be responsive and it’s impossible to always respond in the most nurturing way without sometimes snapping in a manner we may all berate ourselves for after. Our children though teach us the remarkable capacity to forgive these transgressions when we find ‘the place between’ to provide us with the space to calm, think and then apologise. We all want our children to have a beautiful life, free from as much distress as possible- responding to them when they are distressed is one of the best ways to help them for now and for their future.

*Pure speculation, no scientific data to back this figure up whatsoever.

** Leon and the Place Between is a magical children’s book by Angela McAllister and Grahame Baker-Smith about the place where magic sends a boy, perfect for children 3 and above.

Scientific reference

[1] Grusec, J.E. 2011. Socialization processes in the family: social and emotional development.  Annual Reviews in Psychology  62: 243-69.

A piece of you: fetal cells live on in their mother’s brains

Our children are always a part of us: mind controlling children are a reality

This post is written especially in mind for anyone that has had a successful pregnancy or suffered fertility struggles, the loss of a foetus through miscarriage or abortion, the trauma of a stillborn baby, or the devastation of the loss of a child.

If you’re female, what if you discovered that it’s quite possible you aren’t who you thought you were and maybe you aren’t entirely controlling yourself? Freaked out? Interested to know what I mean? Then read on. If you’re male with a female partner, at this point you might already be thinking that this makes a lot of sense, full stop. But still, read on!

For many prospective parents, the journey to a healthy baby in your arms is a long and often stressful one. With the average age of first-time mothers (and fathers) creeping ever higher, so too are fertility issues. It can be months or years before conception is successful and even then so many mothers experience the distress and devastation of miscarriage and fewer but not insignificant numbers also experience the mind-numbing shock of a stillborn baby. Women engaging in sexual intercourse without contraception most likely have experienced miscarriages, with about half of all fertilized eggs dying and then being lost (aborted) spontaneously, typically before the woman knows she is pregnant. The miscarriage rate is about 20% among women who know they are pregnant.

The former happened to me, the first month we started trying for a baby. I clearly felt fertilisation take place and then the movement of the fertilised egg down my fallopian tube and the very beginning of implantation. It was incredible to be that connected with my body, to feel the beginnings of life. Then though, my body went silent; everything suddenly felt wrong and I started bleeding. I couldn’t in any way prove my story but I know it’s true- women when they tune in can have very good insight into the inner workings of their body (this is the focus of an upcoming post). And even though it was just a ball of cells I felt a brief but intense flood of grief over the weekend that followed. This ball of cells felt like it had so much potential. Most likely, though implantation was not successful because something hadn’t gone to plan and this was a quality control measure to protect resources. Eventually my head accepted this idea.

Many women I know though have experienced that second category of miscarriage (or even stillbirth) when miscarriage occurs after they know they are pregnant. In this situation, the grief and sense of loss can be far longer lasting and have profound effects on the wellbeing of the woman and her partner.

What then does this have to do with not being who you thought you were? The excellent and very informed Dr Alison Barrett, obstetrician @DrAlisonBarrett alerted me to the information I am about to share at the New Zealand La Leche League conference where she spoke last year.

It turns out all mothers (and even those that have suffered miscarriages post implantation but never carried a baby to term) most likely have fetal cells living and residing in their tissues, and incredibly for decades. Although it was previously known that fetal cells circulate in mother’s blood[1] a 2012 study by Nelson et al[2], showed that DNA from male cells (most likely from a foetus, but possibly from a sibling) is frequently found (more than 60%) throughout deceased women’s brains (and other tissues). This is called microchimerism, where there is a persistent presence of a few genetically distinct cells within another organism. Note that it’s easy to identify male DNA (i.e. the Y chromosome, which is found only in males) in female subjects, which is why the study focused on the presence of male DNA. Female foetuses will in all likelihood also pass cells to their mother via the same mechanism.

For my early implantation failure, it is unlikely but not impossible any of that ball of cells made its way further into my body and now live on. The route is most likely via the placenta (organ connecting mother to foetus that is the means of exchange of nutrients, gas and waste), after it forms after implantation. The fetal cells it turns out are capable of breaking through the blood-brain barrier, to reside in the brain. They also end up in other tissues such as lung, thyroid muscle, liver, heart, kidney and skin, where they can fuse with cells the mother has to form chimeric cell lines, which is a pretty weird concept when you think about it.

Even more eerily microchimerism has other forms as well.  Foetuses can also pick up cells from a twin, or even an older sibling, as some fetal cells do linger on in the uterus. In a truly heartbreaking story, a mother nearly lost her children through trying to prove they were hers for custody and failing- they had none of her DNA and must have arisen from ovarian tissue from her unborn twin- “she was her own twin – and the twin was the biological mother of her children”. Microchimerism can even occur following blood transfusions in immunocompromised patients. So rather than us being just us, we are not the autonomous beings we thought.

It is bizarre to consider that we carry fragments of others and even stranger when we consider we are used to thinking of our mind as our own. Now though, we know that within our brains we have cells from others living and functioning and influencing how we function in ways we don’t yet understand.

There are potential health implications of having fetal microchimeric cells residing within us. They are likely to play a role potentially in protecting us from disease, tissue repair and cancer prevention and they may be involved in immune disorders. The Nelson study for example, found lower amounts of microchimeric cells in women with Alzheimer’s. And in rats it has been found that if a pregnant rat was artificially given a heart attack that fetal cells migrate selectively to the injured heart tissue[3] and help repair it[4]. Now that is totally incredible! Baby helps mum even before the baby is born. I will expand on what the studies show in a later post.

For me, when I first heard this information I was blown away: blown away because it is conceptually so interesting and seemingly like farfetched science fiction, but also aware that this should be public knowledge for all women. Many women grieve for a baby they lost at some point. To comfort, people often talk about the (angel) baby looking down on them from heaven. However, I think a far more comforting thought is knowing that living pieces of your child are inside you, never leaving your body.

I hope that this really does give solace to those that have experienced this kind of loss. You carry your child with you for life.

And for those of us lucky enough to have children that we conceived and gave birth to, I think it’s also incredibly comforting to know that for the duration of our lives, little pieces of our children also live on in us.

My theory, based on the current evidence, is that the role of these fetal cells is to provide protection to the mother, in order that she is around to care for her child until adulthood and beyond. And isn’t that perhaps the greatest gift perhaps our children may give us? Aside from the way they also visibly enrich our lives on the outside. Could this be part of a mechanism too for how ‘memories’ pass between generations? The human body is really remarkable even now we know the human body is really a humans body.

This is a post in an episodic series I will put out on the wonders of being a micro-chimaera, the incredible world of epigenetics and what it all may mean for parents. Subsequent posts in this series will look in more detail at: 1) these microchimeric fetal cells within mothers and what the science tells us their role might be; 2) the flipside- maternal cells that migrate to the fetus pre- and post-birth and what their role may be; and 3) what epigenetics is and why parents might be interested in it.


Scientific References

[1] Dawe et al 2007. Cell Migration from Baby to Mother Cell Adh Migr. 1(1): 19–27.

[2] Chan et al 2012. Male Microchimerism in the Human Female Brain. PLOSOne 7(9): e45592

[3] Kara et al 2012. A Mouse Model for Fetal Maternal Stem Cell Transfer during Ischemic Cardiac Injury. Clin. Trans. Res. 5:321-328.

[4] Kara et al 2012. Fetal Cells Traffic to Injured Maternal Myocardium and Undergo Cardiac Differentiation. Circ. Res. 110:82-93.

Making mammary use mandatory: why legislative or incentivisation approaches to increase breastfeeding rates are unlikely to succeed & why these measures are an erosion of a mother’s rights

Could being found not to comply with the mandatory breastfeeding law in the UAE see mothers on the wrong side of the law?

Could being found not to comply with the mandatory breastfeeding law in the UAE see mothers on the wrong side of the law?

Breastfeeding has once again been hitting the headlines in the last week, stirring up milk debate around the world with the announcement that the Federal National Council (FNC) of the United Arab Emirates (UAE) has passed a clause making breastfeeding mandatory for the first two years of a child’s life. Breastfeeding at least within the UAE is now ‘a duty and not an option’.

This is indeed an interesting move and one that warrants a little more examination and consideration than any initial response as it raises interesting ethical ideas.

I’m a strong advocate for promoting breastfeeding as the normal scenario for mothers and babies, in line with the official line from UNICEF, WHO and other organisations, whose policies are based on the outcomes of numerous scientific studies.

Note I won’t refer to ‘breast is best’ or state that  breastfeeding gives benefits throughout my posts as breastfeeding is the physiological norm and NOT breastfeeding carries with it numerous potential negative immediate and long term health outcomes for mother and child. I’m also in firm favour of wherever possible breastfeeding to two years and beyond. Thus, you might logically suppose that advocates like myself would be supportive of anything that is intended to encourage breastfeeding and improve breastfeeding rates, including this new law. However, as I’ll explain below I’m not in favour of approaches that do little to educate and empower both mother and child as a whole.

Punishing non breast-feeders

The FNC has been debating the addition of this clause to the new Child Rights Law for some time. There were fierce opponents within the FNC who did not favour its inclusion. The intent of the clause is to foster strong mother-child relationships by maintaining that breastfeeding is a right for all children. This idea (and the suggested duration of two years) is taken from the Quran, although the Quran itself does not suggest that breastfeeding must be mandatory- the derivitisation within the clause stipulates the mandatory nature.

I would say that access to breast-milk (rather than breastfeeding per se) should indeed in these enlightened times be a right for all children. This might on the surface put me at odds with many women, who would argue that it is a mother’s right to choose how she feeds her baby. I’m not arguing against this as I also agree. I don’t perceive a child’s right to breast-milk and a mother’s decision on how to feed her baby as mutually exclusive.

For a variety of reasons, not all mothers are able to actually breastfeed and certainly not all are able to breastfeed for a full two years (I’ll discuss more in later posts how reduced milk supply can arise from breastfeeding patterns particularly within the first 2-3 weeks post-partum). Luckily in Western countries donor milk is now becoming more routinely available, either through formal arrangements such as milk banks or through informal arrangements between friends, now providing a viable alternative for those that cannot feed their babies themselves. In contrast, the alternative arrangement within the UAE seems to be the paid provision of wet nurses for those that genuinely are unable to feed. This may then not be the same (i.e. less empowering) as a mother obtaining donor milk and feeding her child herself, although a much preferred and as paid for by the state, cheaper alternative to formula. There are pros and cons to either donor milk/wet nurse scenario.

Part of the rationale of the addition of this clause is to ensure consistency with existing labour laws that allow working women time for breastfeeding. A clause to ensure all workplaces have a nursery did not pass into legislation although a nursery law proposal not specific to working women will be tabled soon. Thus, it is clear that the UAE is trying to put in other supportive (although still legislative-based) measures to improve the mother-child relationship.

However, the passing of the legislation does allow for husbands to sue wives if they did not breastfeed throughout the first two years of their child’s life. How enforcement would work is unclear at this stage but punitive outcomes could be put in place. I wonder what will happen for mothers who may find their milk supply dwindling between six months to a year and unable to meet their two year quota?

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Opponents argue that such a negative consequences approach will actually lower breastfeeding rates or morale around breastfeeding as women experiencing issues will feel pressure that may adversely rather than positively impact breastfeeding. Parents may hide what they are doing or not doing for fear of losing a child, rather than seeking out support.

Thus, we have a situation where the rights of the child are being acknowledged, which is fabulous, but not at this stage the rights of mothers. Like other advocates, it’s my belief that such an approach will not work. Some mothers within the UAE are also speaking out.

In the UAE, both a woman and her breasts actually belong to her husband. The Child’s Rights Law now makes the breasts the property in essence of the child for the first two years of its life. So at no stage does a woman actually ‘own’ her own breasts. For us living in different countries this is a staggering thought.

And what of mothers who wish to breastfeed longer than two years? I Am Not The Babysitter sums it up here in her post when she says that it will just add to the stigma of breastfeeding. Husbands regain ‘breast control’ at two years of age and may either potentially say Stop or Continue.

If we want to improve outcomes for parents and their children, and specifically here improve breastfeeding rates and duration of breastfeeding, then the key is both appropriate education programmes and strong support systems from hospital bed to home. Women need to feel empowered about the choices they make for themselves and their children.  It’s going to take a community approach to improve breastfeeding rates, not a predominantly law-based one.

Legislative measures do have a place, however, alongside education and mentoring systems. Longer (six months or more) paid maternity leave, nursing and childcare facilities within/adjacent to workplaces are key infrastructural support components that are known to work. In most countries though, including here in New Zealand, we are a long way from the ideal at present.

Rewarding breastfeeding with cold hard cash

Could mandatory breastfeeding become the standard in other countries too? I think that this is highly unlikely in most Westernised countries at least but an opposite and potentially as disastrous approach is being employed in some places.

Last year it was announced by University of Sheffield researchers that a trial was being conducted in some areas of Britain to tackle the very low rates of breastfeeding in Yorkshire and Derbyshire by incentivising through cash payments. If the trial is successful, the intention is to trial the scheme out nationally, before making it a nationwide policy. The trial will record breastfeeding levels and look at the attitude of the mothers to the monetary vouchers given.

Mothers who opt to breastfeed (and regardless of whether they were going to anyway) will receive £120 ($245NZD) in vouchers for chain stores/supermarkets. All they have to do is sign a form saying they have breastfed their child for six weeks. At six months they go through the same form signing to receive another £80 (160NZD). Although the intention is that they buy quality food etc, there is nothing to stop participants spending the money on cigarettes or alcohol. If the scheme is adopted, cash would be given for mothers to spend as they see fit. There is also no way of knowing whether participants are telling the truth.

The idea of the incentivisation scheme is that it will supposedly raise the perceived value of breastfeeding through paying mothers for the service. Although it’s the ‘flip side of the coin’, this scheme in essence is disempowering women in much the same way as the UAE scheme is and it has received a lot of flak. UNICEF released a statement saying that incentivisation may have a role and that “any new research can only be assessed once it has been completed and its various successes and limitations are clear”- in other words- a reasonable ‘let’s wait for the outcomes’. UNICEF emphasise that support is fundamental to breastfeeding success.

To me though, it is frightening to think that these are the solutions that being offered. How can those in charge so easily misjudge people and inaccurately identify appropriate solutions? It doesn’t look like the scheme is associated with any form of education, support and mentoring system.

The researchers involved have defended their scheme and the money invested in it by saying that similar schemes exist elsewhere (Quebec, monthly payments for breastfeeding; India, free food for breastfeeding mums). Just because a scheme operates elsewhere, it doesn’t make it the right choice. The researchers also claim that they surveyed mothers in the target areas who were largely in favour of the scheme- this might be the case, but again it doesn’t mean the scheme will be successful or appropriate. Schemes like this in my mind actually probably cheapen mother’s perceptions of themselves and their behaviours and disempower with the “You do this and I’ll give you this” mentality- there’s a level of handing over control of your body to someone else and I’m not talking about the baby.

Enforcing Caesareans- cutting out a mother’s rights

Where are we heading to if we are intent on fostering change by disempowering rather than empowering mothers? Again in the UK last year there was an alarming case of an alleged forcible Caesarean carried out following the mother supposedly seeking help for a panic attack. The outcome of this was being sectioned under the Mental Health Act, five weeks of hospitalisation followed by sedation and a C-section without her knowledge and consent in order to remove the baby purely for child protection purposes. How far will we go to push parental control out of the hands of the mother?

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Both a mother’s right and a child’s right must be considered

It is a step forward in many ways that the rights of children are being considered and given weight to. We acknowledge the right of the child even as a fetus from a close to midway point in gestation. Knowing the health outcomes of breastfed babies versus formula and advocating for the right of the child to have a chance at the best life possible through a right to breast milk is a further forwards step but in no way should this also be at the exclusion of rights to the mother as this may inevitably lead to negative impacts on the maternal relationship. If we want good parenting then we must put considerable effort into support and mentoring of parents- neither a carrot-based approach nor a cane-based approach fit this manifest.

The researchers and enforcers should learn from positive parenting what really works

Financial incentives and/or legislative change may be one small puzzle piece in improving breastfeeding rates, although it’s personally not one I favour. After all, we use negative financial incentives (taxes) on harmful substances such as alcohol and cigarettes. The University of Sheffield researchers state that “the advantage of financial incentives is their ability to attract and engage their target audience”. It seems to me that this is buying in (excuse the pun) to the idea of entertainment as a solution. I think we parents deserve a little more respect than that.

The approaches discussed above appear to come from the perspective of treating the symptoms (let’s improve breastfeeding rates) and not the cause (why are breastfeeding rates in the UAE and UK (and other places) so low?). Such a solution is the easy way out, that might result in a short spike of improvement as a quick fix but is unlikely to be sustainable in the long term.

Legislators and researchers might be wise instead to look to those of us who use positive, gentle parenting approaches to understand that communication, superb educational and peer mentoring together with widely available nurturing support are likely to have more substantial positive effects on breastfeeding rates. Alongside these approaches as well as increased paid maternity leave, better or cheaper childcare access and breastfeeding rooms in workplaces, consideration should be given to taxing formula in the same way as alcohol or cigarettes, making formula prescription only, investing in milk banks to ensure all children have access to breast milk and even perhaps some incentivising of breast milk donation (like sperm donation, where the money is given outside of the target family and therefore does not impact on that family relationship). In knowledge, not money, lies our future.


An article based on this post appeared on The Conversation UK site on February 20 2014. You can view the article and comments at


Leaving a legacy


The festive season hardly seems a time to be thinking about death but it seems like death has been surrounding us recently in a variety of guises. New pet goldfish Tom and Digger found floating on their sides on separate occasions, floppy fins, eyes fixed, graceful in the grip of death. Funerals were held with speeches about their good qualities as goldfish and pets, fantastic learning experiences for young ones about how we recognise death and celebrate life. They then so lovingly buried under the spinach plants to recycle carbon and nitrogen with coloured iceblock sticks marking their resting places.

Our monarch caterpillars this year have also been dying, some virus circulating around the swan plants and infecting and disabling them. It’s not formulaic in how it hits- they haven’t succumbed all at once or at the same size. Some have carried all the way through to chrysalis stage successfully and we’re awaiting our first butterflies although they will hatch unseen whilst we are away. Others have on the surface also resisted infection, although come time for their remarkable metamorphosis the chrysalises instead have been malformed, grotesque coffins. In the main, caterpillars appear to sleep but then go all floppy, hanging in a V shape pinned by their middles to the plant. Resilience and resistance to the virus and its effects obviously varies and even those seemingly untouched may perhaps be carriers onto the next generation. No different to higher animals like ourselves where there may be no easily explained pattern to succumbing to any one of a variety of diseases and great variation among those affected with respect to what toll an affliction takes.

Death has surrounded us out of the home too. My former cat, Holly, adopted by my sister many years ago when I went overseas, needing to be put down recently due to kidney failure, having lived a full and very happy life. MissBB and I went on a final visit to give many cuddles to this much loved, light as tissue paper 17 year old moggy. It was part of the process of coming to terms with a suddenly scheduled departure that saddened all of us. Instructions were issued to nephews, seemingly unclear that the trip to vet was not going to be exactly the fix-it trip they wanted although fix-it it was, that they needed to give their mother much support and love when the trip to the vet occurred.

The kidney disease had been sitting there for a couple of years, hovering and threatening but Holly fought it gracefully and with style. She shouldn’t have lasted as long as she did and she was uncomplaining, always cuddly and one to comfort us, unless you had her on your lap where the phrase ‘Claws in’ never seemed to resonate. The terminal nature of her illness hit hard when she was first diagnosed, even for me who had long since relinquished parental rights. Once a parent, always a parent. As time went on though, it seemed she was perhaps invincible, one to beat this disease. Humans, if nothing else, are fabulous at holding onto hope.

The text then from my sister saying she was to be put down one recent Saturday jarred and shocked. Death much of the time seems like such an ethereal concept that when put definitively in front of us turns the stomach cold and sets the mind whirring. None of us really want to ponder the finality of our existence and if we do then it seems of some comfort perhaps that ‘the when’ is some vague time in the future. Like Holly we want to live happy, full lives.

Euthanasia is a standard way to ease ‘suffering’ in the animal but not yet the human world- it was probably the nicest thing to do in Holly’s case where she had taken in her demented state to wandering off and may have been run over or unable to remember the way home. I wonder though whose suffering being ‘put down’ (such an odd phrase when you think about it, a put down being a less than flattering comment made to someone) always eases though?- the wallet for certain with vet bills never light in nature and perhaps it’s a way of lessening the grief and burden on the animal owner. Such a timetabled way to die is however, a bizarre concept- not for the pet who has no idea what this final vet’s visit entails. If they did those constant ‘mews’ in the car might be louder and more persistent. For us humans though, knowing a time that something will cease to be alive is weird. Harder still for parents to explain maybe? After all, it seems like an act of killing, of a fashion. Not in general knowing when you or others will die is one of the scariest concepts about death. In our case, more for me really, taking to the photo albums and cataloguing the life of a flat lap cat was a fantastic way to celebrate a feline and pass the time until that lethal overdose.

As death always is at first it was about looking backwards and remembering, rather than looking forwards. Holly had come to us as a pair, her delightful tabby brother Tane was her companion. His life was cut far too short however, at just over six months, being run over in a terrible incident gone wrong of play and ‘child’ rebellion against ‘parental’ command that Holly and I both witnessed. Strangely perhaps, the story of Tane’s gruesome death is one that MissBB has asked me to tell at least weekly for the last year, alongside another equally charming tale of the flea infestation that occurred just after my flatmates and I shifted flats when the two of them were just kittens.

She delights in this story, not because of what happened, but I think as it is part of her way of making sense of the world and of death. Children attempt to understand the world around them from very early ages. It’s approachable to her and I think interesting for her to think that Holly’s way of coping with Tane’s death was then to assume his far cuddlier lap cat persona and to frequently sleep on his grave. A mother’s role in telling such stories to their children to assist them to cope develop emotional skills is possibly an important part of child development as a recent study shows.


Children often don’t have a decent understanding of what death entails (for that matter – do any of us?) until about the age of six or seven. MissBB however, seems to already be well on her way to understanding at four. I’ve never been shy about talking with death with her- after all just over a year after she was born we were devastated by an earthquake here where 185-odd people tragically died and my response to that was to pound the pavements, view the devastation and pay my respects in order to be able to deal with the earthquake aftermath.

Lately, she’s been quite fixated with death and that’s led to some heart-breaking conversations. Having just turned four, she spent a couple of weeks becoming inconsolable when considering her future. The thought of heading to school and turning five brought her to shoulder-heaving sobs. The reason? That turning five and hence school-ward bound meant she was “getting older and when you get older you die”. And she really, really doesn’t want to die, like most of us. Of course to a four year old, another year is a huge degree of aging and to her that spelt imminent death.

Explaining to a four year old that you absolutely wanted them to and hoped that they would live a long happy life and reach 100 at least wasn’t without tears for the teller, but I was aware too that with no omnipotent powers I couldn’t make complete assurances about her future, leaving me pondering the What-if’s no parent want to contemplate. In terms of a book that deals with Death in such a gracious, respectful and indeed beautiful way for children I can highly recommend Duck, Death and the Tulip. It’s a difficult book for adults to read to children and not one I can read without giant lumps in my throat but it does the job well.

Just as the working year at university was about to wind up, there was another shock- the terribly tragic and bizarrely cruel death of my boss’s animal-loving wife when they hit a stray horse driving home from a Christmas function. My way of dealing with this news was to pick some wild elderflowers on the way home and stop with my daughter to lay them on the accident site (in other words tackling it head-on- regrettably not the best phrase to use in this situation but it’s the best to sum up my coping strategies). This was an act MissBB was intent on participating in with many questions, many of them focussed on where the horse went to and why it still wasn’t at the scene. Most of my department headed to the funeral a few days later on a blazing hot day where many had to stand outside, probably skin burning listening to a very long life celebration. I barely knew her, having met her only a couple of times, but she sounded like a fascinating women and most of all an incredible mother to her daughters. I found myself watching the photos flick over on a screen that followed the diverse speeches, suddenly filled with emotion.

The upwelling wasn’t so much about the loss of a life, although naturally this saddened me greatly, but the watery eyes and feelings were about considering my own legacy as a mother. Funerals are all about a reflection on a life but they are also often a window into our own soul, provoking and promoting philosophical thought on our own existence. How did I want to be remembered by my daughter? What sort of mother did I want myself to be talked about? I hope one considered to have always done the absolute best for the most beautiful gift bestowed on me, one to have dished out unconditional love and more hugs, kisses and cuddles than is nearly possible to fit into a lifetime, to have nurtured in every sense of the word, to have been a staunch advocate for my child, a mother that taught fantastic values, inspired, imparted knowledge and a great love for the planet, its inhabitants and respect for anything that lives, including other humans. A mother that could demonstrate forgiveness and one that could apologise and also admit their own ignorance. A mother that wasn’t afraid to continue to learn or to listen. A mother that told the best stories, was fun, danced. A mother that was kind, encouraging, full of praise, gratitude and respect. The list goes on.

Not that I wanted to contemplate my death or the fervent hope that MissBB outlives me as children should. This is one of the sad realities for most parents- never getting to see the full potential of their children’s lives. Thoughts of either make me feel sick. Just two days later though the opportunity to converse with Death (like Duck, Death and the Tulip) hit in the shape of a health scare. I found a mole on my back, which at first I wasn’t sure had even been there before, that had changed suddenly- got bigger, turned multi-coloured and ugly.

My mother had had a melanoma on her leg twenty years ago and in a panic had sent me off to the doctor to have all my moles removed- all 15 of them, so I was ‘safe’. Then I discovered like her I form ugly keloid scars. In the meantime though, despite the war wounds, more moles grew- not many, but this suspicious mole was one of them. Perhaps it was all the build-up of the other deaths, but the thought I could have cancer sent me into a complete panic. I felt twisted in knots, even more so when I read some things on the internet, like all of us do, and combined it with my existing knowledge. The dangerous territory of self-diagnosis and the blurring of the lines between that and truly being informed.

It was the weekend and no chance to get a doctor to look at it until Monday. I couldn’t sleep or eat properly. I found it difficult to function and it was impossible to hide my state from my daughter who saw me alternating between some form of despair to a fighting resilience. I sometimes engaged in private conversations with my mole – “I am going to be around for my daughter- she needs me and for a long time yet- so you can f*** off”. Family members who I got to look at the mole affirmed that it didn’t look good, which just heightened my worry although two days later it wasn’t as bad as when I first noticed it and it looked like I had been scratching around it with some small scabs around the area, which left my husband and I wondering whether it was just trauma. I would normally consider myself a pretty strong person (and I think my friends would too) but the thought of dealing with the big C left me weak at the knees initially before I started to calm down a bit and attempt to find my resilience. The best person to help me with that?- MissBB “Don’t worry Mama- you’re going to be ok”.

She didn’t want to come with me to the doctor because she didn’t want to see them cut the mole out so unusually I went totally alone and my cortisol response went through the roof. Pondering my future and what I would do if it was cancer was unquestionably terrifying. What could be the future of a girl that like any child needs maternal and paternal care? Cancer to me has always seemed a totally terrifying, insidious and horrible disease. As it turned out I got myself into a state about nothing at all except trauma done to my mole, which made it look bad- I must have knocked it somehow. It’s had a few spin-off effects though in the come-down on the other side. I’ll be ever so more vigilant about my skin in the wake of this. I also have just the smallest insight into what it is like to be a parent diagnosed with something like cancer and I can tell you it ain’t pretty. I have full respect and empathy for those in this situation. People like the very brave Jennifer Dooblah who chose to stop treatment for her aggressive breast cancer when she found out she was surprisingly pregnant with her third child and has just delivered a healthy baby, only six weeks premature.

It was fascinating too reflecting on my response and noting how since becoming a mother consideration of death was now largely centred on my role as a parent and the needs of my child. It got me wondering about those that are diagnosed with a potentially terminal illness such as cancer and wondering how much do parents actually fight to stay alive? Thinking about my own reaction, I thought that perhaps that those who have children might fight harder than childless adults, which may be reflected in higher survival rates in the former. Either that, or the exhaustion of parenting may see them with little energy left to combat their disease. My money is on the former, but I took to searching the literature to see what I could find out. Anecdoctal evidence from stories of friends and relatives provided some support for my hypothesis. And Dooblah’s story itself suggests similar: “Because she wasn’t having treatment, her condition worsened and at 22 weeks, she was given six weeks to live.”I was getting ready to die,” she says, matter of factly. “We were getting everything ready for the funeral and I was getting ready to die. The family and doctors met to discuss what to do. For Matthias to be born healthy, she was told she would need to make it to 28 weeks. She decided to start chemotherapy again…. “You can’t just kill a baby””.

Surprisingly, for perhaps such an obvious thing to assess there is very little that I could find in my searches, although if others know of studies not listed below, I’d love to see them. Most of what I could find actually relates to parents of children who have had cancer and not the other way round. I have also found some fascinating health differences between childless adults and parents, which will be the subject of another post.

The first indication my hunch was correct is the finding by Agerbo et al in 2012 that death rates (not just cancer-related but including cancers) are between two to four times as high among childless couples- having children does not shorten your life- in fact the converse. Indeed the early death rate from a variety of causes among childless women was four times that of those who had given birth to their own child and 50% lower in women who adopted. Similar rates were found in males who were childless versus who had become biological parents or adopted. The authors state “Mindful that association is not [the same thing as] causation, our results suggest that the mortality rates are higher in the childless”.


Most studies looking at mortality and morbidity do not adequately discriminate between marital status and parenthood. However, a group of researchers (Kendig et al 2007) conducted a thorough analysis of existing literature and then analysed their own data. A consistent literature finding was that ever-married women with no or an only child as well as those with greater or equal to five children have higher all-cause mortality rates than women with two to four children. Overall they found in the literature higher mortality in childless women than those with 1-4 children. For males, they found the lowest all-cause mortality in fathers living with their children and a partner. A Finnish study found that mortality for most cancers and other diseases, accidents and acts of violence were higher among women without children at home versus mothers. Controlling for marital status, employment, occupation, and education did not alter the differences.

Competing hypotheses exist for the health effects of the multiple roles people may occupy (a reality of today’s existence for many). Are children a double burden or double blessing? The role strain hypothesis suggests decreased wellbeing with role overload (too many responsibilities for available time/energy) and role conflict (difficulties involved in attempting to meet competing expectations, irrespective of time pressure). Role overload plus role conflict are proposed to lead to exhaustion, contributing to disease and death. Role accumulation on the other hand suggests increased wellbeing from multiple roles through increases in self-esteem and identity. Hendig found the weight of literature evidence favour the role accumulation hypothesis although there is disagreement from others on this. Their own data showed variability across countries (Australia, Finland and the Netherlands), which may be genuine sociocultural differences or a sampling artefact. There was a general trend towards poorer health in men without children, particularly if they were formerly married with similar, lesser trends for women. Thus, having children may lead to better life outcomes and this could potentially include survival from disease.

For the majority of young cancer sufferers, their illness increases the value they place on parenthood and family ties a study by Schover has found; although having survived cancer they were more prone to being disproportionately anxious about pregnancy causing a cancer recurrence and even more so that their future children would be at high risk for birth defects or cancer. Studies have shown that for women at least, having cancer young and the corresponding infertility that may occur is nearly as painful as the cancer itself- the desire in humans to have families is certainly very strong. It may potentially not be the case for Jennifer Dooblah, although one hopes so, but Schover points out that even for breast cancer, both diagnosis and treatment during pregnancy does not lead to survival outcome differences (when matched on cancer stage and histology results).

How families communicate is vital during the cancer experience as there is obviously a multitude of concerns and worries and yet as Harris outlines (2009) we still don’t understand much about the complex processes of how and why information is transferred during the cancer experience. There’s been scant attention paid to the impact of cancer on fathers – this is especially relevant as father’s roles are evolving and whilst there are many commonalities between men and women when diagnosed with cancer, they have also been shown to experience differences.

Increasing survival in cancer due to medical advances is however, resulting in an increase in psychological problems in patients and their relatives, including in children. When children are the cancer victims, parents exhibit very high rates of post-traumatic stress (PTS) symptoms and PTS disorder, with perhaps unsurprisingly mothers being most affected. When children are bystanders watching affected parents they suffer considerable distress (as I am sure do the affected victims), but Spath et al showed that their emotional adaptation does become significantly more positive over time.

Clinical psychologist Kumari Valentine and Lecturer in the Department of Psychological Medicine, University of Otago, points out that survival may be linked to meaning. Viktor Frankl’s “logotherapy” is based on the premise that when people can make meaning out of what might be negative experiences, their wellbeing is actually enhanced- striving to find meaning is the most motivating force to live. Kumari also alerted me to a theory called Terror Management Theory (TMT), first proposed by Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski. TMT suggests there is a basic psychological conflict unique to humans, which creates terror, as a result of the desire to live but realisation that death is inevitable. So, whilst we fear and avoid death like other animals, we are conscious that we are mortal. The solution to the conflict is also unique to our species: culture, as cultural values serve to manage our terror of death through giving our life meaning, linking back to Frankls finding meaning strategies.

Kumari says: “We create a cultural world view that makes sense and we get self-esteem (which buffers us against this terror) by living up to this world view. We also do interesting things, consistent with this, when primed with death (e.g., when experimental participants are primed with images of cemeteries, etc). As expected, people hold their world view more strongly (e.g., those who are conservative become even more so) and there is in-grouping/out-grouping (where those part of the world view are viewed favourably in contrast to those who are seen as outsiders).”

Kumari, when presented with my thoughts regarding survival rates in childless vs. parents with cancer replied: “Thus, leaping from the (TMT) theory, I would wonder if, primed with death, we became more “fixed” on our world view (ie.., that children were definitely part of our ingroup/legacy, etc) and we “value” them more”. I think Kumari is likely to be spot on with this idea.

Most of us parents have probably relatively easily, if not devoid of emotion, sorted out our wills and guardianship should we die. How much thought though have you given to how you and your family would truly cope in the face of something like cancer? For those living with their children the odds look like they may sit a little in your favour.

Was I about to die? And if I died now, what would my life have amounted to? There was no way I could answer that. All right then, what was death? Until now I had conceived of sleep as a kind of model for death. I had imagined death as an extension of sleep. A far deeper sleep than ordinary sleep. A sleep devoid of all consciousness. Eternal rest. A total blackout.

But now I wondered if I had been wrong. Perhaps death was a state entirely unlike sleep, something that belonged to a different category altogether- like the deep, endless, wakeful darkness I was seeing now. No, that would be too terrible. If the state of death was not to be a rest for us, then what was going to redeem this imperfect life of ours, so fraught with exhaustion? Finally, though no one knows what death is. Who has truly seen it? No one. Except the ones who are dead. No one living knows what death is like. They can only guess. And the best guess is still a guess. Maybe death is a kind of rest, but reasoning can’t tell us that. The only way to find out what death is is to die. Death can be anything at all.

Sleep, by Haruki Murakami in The Elephant Vanishes.