Just who is brandishing the switch?

I have noticed myself getting fairly ranty lately. I briefly struggled to resolve being an angry activist with being a gentle, non-judgemental doula, but then I realised, it's the balance, it is the mama bear saying "LEAVE THE POOR MUMS ALONE" Grrr.

You see the thing I get most angry about, is when women are denied the freedom to become and continue being a mother on their own terms. To listen to their bodies, to respond to their babies and to do what they know is right. In close second place are those who, although not denying a woman her freedom,  support her inappropriately so as to insidiously undermine her confidence, and make her feel guilty for doing what feels right to her, leaving her with no comfortable option.

I am talking about the "rod for your back", and I shall begin by giving an example.

Imagine a new mum is tentatively planning a night out, the first one since birth. Perhaps she is aching for some time alone with her partner, perhaps she is a bridesmaid feeling obliged to attend a hen night, it doesn't matter really. Nor does it matter how she chooses to parent for now, what matters is how people respond to her. Imagine she updates her Facebook/Twitter or posts a question on a forum and it goes something like this:

"I'm really nervous about leaving baby for the first time this weekend"

You can guarantee that amongst the replies you will find some variant of the following:

"Oh no, that's far too early to leave him, he'll miss you so much, you aren't going to drink are you?" 

and

"Leave him, it will do you both good, he needs to learn to be independent or you are making a rod for your own back",

[inevitably I read both of these and have to go and have a little lie down, and this is why...]

Both of these replies suggest judgement. What does she do now? If she goes out she is a bad neglectful mother in the eyes of her friends/family (or gods forbid, strangers on the internet), if she stays in she is cultivating a mummy's boy who will still be co-sleeping with her when he goes to university (and that could be awkward).

But she didn't ask for judgement. We can't be sure whether she was looking for reassurance to give her peace of mind, or permission to change her mind and stay with her baby, but these responses won't help either way. What she needs is to be listened to, and given the opportunity to process her options in an environment that reassures her that she has the ability to come to the right decision for her and her child.

"A rod for your own back" is my most detested phrase in child rearing, as an "Attachment Parenting" mother I have heard it quite a lot. It is a horrendous threat of some imaginary consequence of the mother attending to her baby's needs. It leaves a mother either upset by not being "allowed" to have the closeness with her child she physically craves, or feeling guilty that she is moulding them into a  non-functional person. It is not the future child that will punish the mother for her choices, it is the person making the judgement, right here, today.

The thing that strikes me, is that the critics who threaten mothers with the futuristic stick are rarely going to be exposed to the consequences of  the parenting in question. Is the neighbour, aunt, or old schoolfriend going to be affected if an 11 month old is still nursing to sleep? Highly unlikely, but we can't help but interfere. They say it takes a village to raise a child, and it is certainly true that people always seem to have an opinion and a strong urge to relate it when a child is involved.

I think it's lovely that even nowadays people to take a community interest in raising children, and it is wonderful when awareness is raised, people are educated and children benefit as a result. But before we go sticking our oars in, lets try to pause for a moment. Listen to the parents, what are they asking of you? What do they want? How can you give them information without alienating them? And most importantly, how valid, in their world, is your opinion? Are you going to make life better for the parent, or worse, and if it is the latter, can you just sit on your hands until the urge passes?

[Postscript: I deliberately avoided making this into a comment on the benefits, or otherwise of parenting styles, but for reassurance: My co-sleeping baby now sleeps in his own room, it took very little effort because he was ready; the baby that nursed to sleep well past a year old eventually stopped, and now settles himself happily singing to his bears; and the baby I "never put down" now runs away up the climbing frames at soft play and won't come back to me for 4 hours, even when tempted with snacks, until I physically wrestle him out of the place. On baby number 2, I now have no fear of the rod.]

Not saying yes.

I was going to write about yoga today, but a conversation on a certain high profile parenting forum inspired me to bring forward a post I wanted to write in the wake of the release of the film Freedom for Birth.

The discussion, like the film, was about bodily autonomy, a woman's right to decide what happens to her body, specifically during birth, and a woman's right to refuse or withdraw consent for any procedure.

A common response to the fact that a birthing mother does have the right to say "no" was a concern that the procedure she is offered may well be life saving for her or her baby, and perhaps that no caring mother would refute the recommendations of her medical carers. There seems to be a confusion here, that a woman not following the policy of her health service trust is wilfully and ignorantly endangering her health and that of her child. There also seemed to be the impression that to refuse consent to a procedure, was to refuse all medical intervention.

The standard policy of your maternity unit may be exactly suited to your situation, and explaining your right to follow another route, is not intended as a critique. These policies must be based on a combination what is best for the "average" mother and baby, and what is best for the hospital (in terms of resources, legal fallout etc). Not all mothers are average, sometimes what's best for the hospital is not best for the patient. Sometimes an individual hospital has yet to update their policies to meet with NICE guidelines, so not take into account more recent research evidence.

So this post is not, as planned, about your right to "say no", it is about what you can say instead of "saying yes".

Before we start though, I should make the key fact clear, that even when in a life threatening situation, no medical intervention can happen without the informed consent of the patient, or their next of kin if they cannot give informed consent. To continue with a procedure without consent is a criminal act on behalf of the medical professional, they will always seek consent (even if it as phrased as "I'm going to examine you now,OK?"), and you have the right to respond as you see fit.

So what measures can we take to ensure our right to choose the circumstances of our childrens' birth (as confirmed by the European Court of Human Rights) is exercised, without putting ourselves and our children in harms way. I'm going to break it down like this:

Before the birth-
1) Take preventative measures to reduce the likelihood of an intervention becoming necessary.
2) Inform yourself of all the options when you make your birth plan.
3) Plan in advance for all eventualities so as not to be put on the spot.
4) Have an informed, birth partner ready to objectively support you in your decisions.

During labour.
5) Ask your health care professionals to fully inform you about the intervention they are suggesting.
6) Ask your HCP why they are suggesting this intervention over an alternative.
7) Ask for an alternative intervention.
8) Ask to wait and see if the situation changes.
9) Ask for a second opinion.
10) Have the intervention on your own terms.

Before labour, your toolkit for avoiding the question...

1) Take preventative measures to reduce the likelihood of an intervention becoming necessary.

There is a lot of research evidence linking certain practices in pregnancy and labour to reduced levels of intervention, usually by encouraging the natural processes and having patience and faith to allow them to unfold. When making your birth plan, try to be positive about what you will do to improve the birth process, rather than simply listing the things you don't want to happen.

In brief, you need to promote the production of oxytocin. If birth isn't progressing in hospital, it is often recommended that you supplement with synthetic oxytocin, which has a range of side effects, including reducing your natural oxytocin production, and is often the beginning of the cascade of intervention*. Oxytocin is "the hormone of love" you produce it when you feel safe, relaxed and loved, when you look someone you care about in the eye and when you feel a caring touch. Dim lights, comforting sounds and smells, keeping strangers away from you, massage (if you feel like it), kissing (ditto), hugs, your birth partner in the pool with you - all this will promote oxytocin and keep your contractions strong. Some alternative therapies, such as clary sage oil on a sponge to inhale, will also help.

It is often said that a baby's position is more important for a smooth delivery than their size. It is certainly true that the dilation of the cervix depends upon an even pressure being applied from the baby's head. It is well known that OP (back to back) labours tend to be longer and more painful, increasing the likelihood that you will be offered augmentation (a drug to speed up labour) or want pharmaceutical pain relief. Optimal Foetal Positioning (OFP) uses various exercises and lifestyle changes to improve the chances of your baby engaging in a good position for birth. In a good pre-natal yoga class you will be taught exercises to help guide your baby into position. Moving around, changing position and moving your hips during contractions will help position your baby in early labour. If you know your baby is in an unfavourable position Spinning Babies has a range of techniques to help encourage them into a better one.

Water birth encourages all the good things in birth, you are upright, supported, comfortable, you can easily change position, and it is quite hard to interrupt a woman in a birth pool for interventions or superfluous checks. Water is excellent, soothing pain relief. You don't need to deliver in water, but I would thoroughly recommend it during labour.

Planning a home birth. Rates of intervention are much lower in planned home births, even when the mother transfers to hospital. The Homebirth Reference Site is full of information and links to relevant studies, anyone interested in informing themselves about birth (even hospital births) should check it out. At home it is much easier to have an active birth, and maintain an oxytocin friendly environment. As you are on "your territory" it is often easier to stand firm on your decisions, the dynamic of power between you and the midwives is very different. Women who have previously had caesareans are more likely to have a vaginal birth if they stay at home longer before going to hospital (VBAC facts is a helpful resource of you are in this position, as is the homebirth site above). If a home birth is not suitable, consider a midwife led unit (MLU). When choosing a hospital, statistics are available which give an indication of the intervention culture of the unit (but be aware that a consultant led unit will have a higher proportion of high risk births, and therefore a higher rate of intervention if it is close to or associated with an MLU. as the low risk women will attend the MLU, and any complications there will transfer to the CLU). Tour your intended place of birth, and ask plenty of questions.

It is worth considering that some interventions that you may not object to, may increase your risk of needing other interventions, for instance continuous electronic foetal monitoring is associated with an increased rate of emergency sections (but no change in outcomes for mothers or babies), this is often referred to as a cascade of intervention*, and you may wish to avoid an apparently benign intervention for this reason.

That was a long one, but a good birth really does begin in good, positive preparation.


2) Inform yourself of all the options when you make your birth plan.

Birth is a bit like playing poker, you can't really help what cards you are given, but with the right  knowledge and skills you can make the best of the hand you get.

You don't need to become a self made expert, but do talk through your birth plans with a sympathetic midwife, ante-natal teacher or doula. You need to be aware of the options available to you, and the pros and cons of various routes. If you are offered an intervention, it is well worth knowing the alternatives so that you can ask for them specifically. If you aren't going to follow the standard policy you need to understand why, and your HCPs will be a lot more understanding and supportive of your choices if they are reassured that you have good, educated reasons.

3) Plan in advance for all eventualities so as not to be put on the spot.

It's good to be positive about birth. Hypnotherapy for birth often involves visualising your ideal birth experience, making it real in your mind and inspiring you with confidence.

If, however, you some up against an unexpected hitch, it is worth having considered how you might tackle it in advance, and even including that in your birth plan.

For example, you may not want continuous monitoring, but if a complication arose that indicated it were necessary, you could ask not to be sat on the bed, but on a birth ball instead. If the birth pool were unavailable, what would your back up natural pain relief be?

In my birth plans, despite planning home births, I also had a section on how I would like things to be handled if I transferred to hospital, and another in case I needed surgery. It's OK to have a Plan B, and a Plan C, going off your original plan doesn't have to mean automatically reverting to the default.

4) Have an informed, birth partner ready to objectively support you in your decisions.

Support is absolutely key. During birth your higher brain takes a step back and your primitive hindbrain takes over. You may find it hard to process questions posed to you, or understand explanations, the effort of doing so will take you out of your birthing frame of mind and disrupt the process. No matter how intelligent and strong in your convictions you are now, in labour you are vulnerable. Besides, you have more important things to focus on than asking questions.

Your birth partners need to be completely supportive of your choices, they don't have to agree to them, but must be committed to following them through with you. They should be familiar with your birth plan, and have their own copies for reference. Should they have to advocate for you, it is easier if they have a written version of your wishes to hand. They should be capable of following the points below, asking questions on your behalf, and "translating" the situation to you should it become busy or overwhelming.

A doula is a good option, as she should be well informed and be able to direct you towards information and options you may not have heard of otherwise, and as an objective servant to your needs, she should support you regardless of her own opinions or emotional involvement. You may have a friend or relative who can do this for you.

It is also worth having 2 people whose sole responsibility is your care. They can also support each other, take breaks and fetch and carry for you without leaving you on your own. If you are having a home birth, and have older children in the house, it is worth having a 3rd person to take care of them, especially in case you need to transfer to hospital, as you can then have both your birth partners with you in hospital.

With all this in place you should be fully prepared for your own tailor made birth.

During labour, alternatives to saying "yes".

5) Ask your health care professionals to fully inform you about the intervention they are suggesting.

To give informed consent, you need to be informed, all HCPs are familiar with this, and will be very happy to explain the situation if you ask. I would not suggest at all that you argue with your HCPs, expect them to be open to a frank discussion of your care.

A good thing to remember here is to "use your BRAIN":
What are the Benefits of the suggested course of action? Why is it being suggested?
What are the Risks or side effects of the intervention?
What Alternatives are available to me?
What does my Intuition tell me? Birthing mothers are often incredibly good at knowing what they need, if they listen to, and trust their body.
What would happen if we did Nothing? Not necessarily forever, but it is perfectly reasonable to ask to wait 20 minutes, and reassess the situation, go through this process again, and see if you feel differently then; if not, wait another 20 minutes. There are very few situations in birth where such a wait will cause an issue, and if you are experiencing one of them, your HCPs will tell you.

6) Ask your HCP why they are suggesting this intervention over an alternative.

This fits with the points above and below, but it is a key point. Is it safer? Is it quicker? More likely to succeed? Is it due to staff training, experience or preference? Is it because it is most suited to your current situation, or is it the default?

7) Ask for an alternative intervention.

The first option you are presented with is unlikely to be the only option. Rather than going into a lot  of detail here  on the pros and cons of each, I am going to present you with some alternatives to common interventions, that are worth researching or asking about:

Instead of forceps, ask about ventouse (it is often, but not always offered first), if you are able, ask to wait a bit to stand up and walk, sway your hips or shake your legs (yes really), or just turn onto all fours, a change of position often makes pushing easier.

Instead of an episiotomy "in case" you tear, you can ask to be left to tear, there is evidence that tears are often less serious and heal quicker, you also might not tear at all. You are less likely to tear in water.

Instead of an elective section at 38 weeks, you can ask to wait until you are full term, or the first signs of labour, to ensure your baby is really ready.

Instead of being induced when you are "overdue", you can ask for expectant monitoring, to check your baby is happy and healthy, and choose induction only if a problem is detected.

Instead of an elective section for certain "high risk" births such as twins, breech or VBAC, ask about vaginal delivery. It is worth knowing that although the consultant in charge of the unit may have a preference for caesarean delivery, other doctors or midwives on the unit may have the skills and confidence to support you in a vaginal delivery, but it is up to you to ask.

Instead of directed pushing (coaching) ask to be allowed to follow your own body's cues (this may mean waiting a while before you feel the urge), if you have an epidural, you can ask to let it wear off for the pushing stage.

Instead of continuous electronic foetal monitoring, ask for intermittent monitoring.

Instead of augmenting a slow labour with synthetic oxytocin, try moving around to help the baby descend, encourage oxytocin with cuddles, massage, dark, privacy etc. Use acupressure points to encourage contractions, clary sage oil and.... patience.

8) Ask to wait and see if the situation changes.

Birth is a dynamic process, and the situation changes constantly. If there is indication that an intervention might be beneficial, it may be worth waiting for a little while, and seeing if things change. If for instance early labour seems slow, you can take that time to withdraw to a calm, oxytocin friendly environment.

It is also worth having the time to carefully consider your situation without the pressure of an audience of medical professionals.

9) Ask for a second opinion.

If you are not happy with the dialogue between yourself and any doctor or midwife caring for you, you are always able to request the opinion of someone else. In the worst case you can ask that someone else takes over your care, but hopefully a fresh perspective in the conversation will clarify the outstanding issues.

10) Have the intervention on your own terms.

Sometimes, after exhausting the alternatives, a mother-to-be finds herself facing a birth very different to her plan. There is no need to completely throw away all of your plans, it is possible to maintain control and make the best of the hand you have been dealt. It is much easier to face these situations if you know that it is still your final choice.

Look at your plan and consider which key parts are important to you. Consider how they could be transferred to your new situation. Birth partners can help make your hospital delivery room homely, you can have your own music, low lighting, you can restrict the number of people that come into the room.

If you wanted to be upright and active, but need monitoring consider sitting on a ball or kneeling resting your upper body on the bed or a chair.

Even when there are major interventions, you can still insist on skin to skin contact immediately after birth (even in an operating theatre). Delayed cord clamping is possible, even after an emergency caesarean

Small changes like this will help you feel better about your birth, even if it doesn't go to plan.

There is far more I could say about alternative birth planning, but hopefully this overview has been enough to make it clear that choosing not to follow trust policy in your care plan, is not equivalent to forgoing all medical assistance; in fact what it is really about is starting a dialogue with your HCPs, saying "OK, I get why you want to do this, but can we discuss something else that I am more comfortable with?" It opens up a myriad of options, which may be better suited to you and your baby. Exercising your right to bodily autonomy is a gateway to choice.

*Cascade of intervention. Synthetic oxytocin produces strong, painful contractions without the high of natural oxytocin to soften it, many women find they cannot manage without an epidural, which means they will end up lying on their back. Even without an epidural, it is known to increase foetal distress, so electronic foetal monitoring is always used, which usually means lying down, and is associated with more emergency ceasareans. Unable to be upright and active the mother often needs instrumental assistance to deliver the baby, and the increased risk of foetal distress leads to a greater chance of needing an emergency caesarean.

Toddler living.

I am drifting away from pregnancy and birth, and into parenting for a bit, after an interesting morning with my 2 year old.

We were attending a local stay and play session, as we do every week, and I was aware that afterwards I would need to go and buy some bread and bananas in town, before going home for lunch. As we walked up the high street, my eldest made it clear that he wanted to wander into an adjacent courtyard of shops, rather than straight up to the baker. I paused for a second, he seemed quite insistent, so I decided to follow him and see where he took me. We looked in some windows, and chatted about them, and he watched a couple of dogs, then he decided he wanted to go up the stairs to the Goddess Temple. It wasn't open yet, so I suggested to him that perhaps we could get some lunch in town, and go back later.

Over lunch it occurred to me, why not let go of my plans for the day, and see where he took me instead, like dice living, but with infinite possibilities and fanciful logic. I recognised that there would be limitations, we were also accompanied by my 12 week old, in a sling, and I knew that his own whims may not neatly align with his needs (I could see us ending up the other side of town from the car when he decided his legs were too tired) but I could keep a handle on that.

It wasn't an unmitigated success to be honest. I had to cheat and hustle him along after 2 minutes stood outside an estate agent point at the floor saying "sick" and then looking over his shoulder and saying "lion", over and over, for no apparent reason. I had to refuse to go into his favourite cafe, as we had just had lunch and needed the last of my change for bananas, also I didn't really want to hang out in the bank. I didn't fancy standing in the middle of the road to look at the clouds, so I got him onto the pavement first.

But we did spend a very long time looking at a fluffy black dog, stopped to listen to a busker, thoroughly investigated some of the beautiful Halloween window displays (without going in to spend money we didn't have), pretended a sandwich board was a castle, walked at a slow enough pace to appreciate every gum stain on the pavement, and ran all the way down one street, because a little girl ahead of us was. He also held my hand a lot, not because I made him to keep him safe (I had his reins on in case of bolting into traffic), but simply because he wanted to.

I am very glad for this little experiment. All too often I find myself bustling through errands, hurrying him along or stopping him from wandering off, to fit into a self imposed schedule. It's really refreshing to follow his impulsive and inquisitive viewpoint. He's not loitering, he's learning; he's not running off, he's exploring. No wonder he gets frustrated when he isn't allowed to do it. It's actually pretty impressive how many thoroughly interesting things a curious toddler can find walking down the street, how much learning there is for him, right under our noses, if I stop to let him look, and to talk to him about it all.

It's definitely a game we shall be trying again soon.

Being a birth partner

"If a woman doesn't look like a goddess during labor, someone isn't treating her right"
Ina May Gaskin


As a doula, it is my job to support women on a practical and emotional level, through pregnancy, birth and the postnatal period. It is a task that I often share with the partner, family and/or friends of the mum-to-be, so inevitably it is also my job to support them, and to help them to be as much help to her as they can be. In fact I would much rather do this, then step back and allow the closer family unit to provide the more direct support. So lets assume you are one such birth partner.

Your friend, daughter, sister or other asks you to be the person to support them in their labour. How exciting! Also, daunting, and scary and "oh crikey, what am I supposed to be doing?" So here are my top tips for being a top birth partner.

1) Prepare with her.

I realised fairly on in my doulaing, that it is a very zen profession, it's about being, rather than doing. One of the things that brought me to this realisation, was a client telling me how simply confirming that I was to attend her birth, made her feel better about it. When approaching labour myself for the second time, I understood why; knowing who is going to be with you when you are in labour allows you to more clearly visualise how it will happen, putting faces on the people who will be with you really helps, and knowing that they are people you can trust takes away a lot of the worry.

So once you have agreed to be with a woman, you need to reassure her that you can be depended upon and trusted, you need to keep building the relationship which you presumably already have (that's why she asked you) and help her to build that strong, positive picture of a peaceful birth surrounded by people who love her.

2) Know her plan.

Preparation also has a very practical side. Every woman has different preferences about how they want to bring their child into the world. Talk through her birth plan so you know what to expect. Who is going to be there? What pain relief does she plan to use (and is there anything you need to do to aid this, e.g. learn how to place the electrodes for her TENS machine)? What kind of atmosphere does she want in her birth space?How does she feel about medical intervention? Does she want the ergometrine injection to deliver the placenta, or would she rather wait for it to come naturally?

You should be able to arrive for the birth fully prepared to support her in her choices. You won't be able to speak for her, but you can remind her* (or the medical team) of the detail in her birth plan when necessary.

[*It should be noted that when I say to remind her of her birth plan, I don't mean crossing your arms and tutting and saying "you said you didn't want an epidural"; more along the lines of "you said you wanted to try using a TENS machine, do you feel that might help now". because I completely forgot I had a TENS in my second labour.]

3) Be available.

The natural length of pregnancy is 37-43 weeks. The baby will usually arrive when it is ready, and the estimated due date given by the midwife is only a vague guess (only 4% of  babies arrive on their due dates). Therefore you need to be ready to be at her side, within good time, for that whole period, or at least for 2 weeks either side of the due date. This may mean making sure your work can be flexible, putting off any trips  too far afield and keeping a packed bag by the door so you can be out with as little fuss as possible.

Some births start very quickly with little warning, so it is best if you can always be able to get to her within an hour or so. Even if the labour isn't very fast, an hour can be a long time for a labouring woman to be alone, the less time it takes to get to her, the better, she will appreciate knowing you will be right there when she calls. Keep your phone on at all times, and let her know if you have to be out of signal range, or switched off for any period of time, so she doesn't panic if she can't get through.

4) Be present.

When I say "be present" I am not talking about being physically there, we just did that. You need to be focussed on being with her. Switch your phone off (or put it to one side on silent if you need to periodically check it) and engage with her needs. This may mean spending time with her, talking to her, rubbing her back etc, or it may mean taking a step back and concentrating on maintaining a peaceful space for her. Whatever you are actually doing, you need to completely commit to supporting the birthing mother, wholeheartedly.

5) Leave yourself at the door.

The birth space is sacred. However you look at it. You can think of that literally, in spiritual terms, or if you can't stomach that, think of it scientifically. Birth is controlled by a delicate balance of hormones, get it right and she is riding waves of endorphins, get it wrong and her progress can slow, stop completely or even regress. Fear or doubt are inhibitors of birth, love and comfort promote it.

When you enter that space it is important that you do not bring all your "baggage" with you. Work stress, a fight with a partner, fear for the mother-to-be, none of these things belong here. Drop them at the door. Similarly your own pre-conceptions, judgement and even negative experiences of birth. Walk into that room with nothing but love and support, you are there for her, and nothing else.

When I enter a house as a doula (even as a postnatal doula), I imagine a large pot at the door, where I dump "myself", my troubles, preferences, the daily grind, and cross the threshold pure in purpose. Supporting a birthing mother when I myself was pregnant, I was repeatedly confused that the midwives kept making comments like "you'll be next". I had honestly forgotten about my own pregnancy, it was irrelevant here, and I certainly did not need to be bringing my expectations or issues about my own birth into someone else's space.

6) Make her the centre of your universe.

There are very few occasions where the focus of an event is just the needs of one person. Birth is one of them. The mother-to-be will always be the most important person in the room, her needs, indeed her whims should always come first. So give yourself up for a few hours and watch her turn into a goddess.

What will my new baby need?

Something that has come up in discussion a fair bit recently, is shopping for a new baby.

My second baby is 7 weeks old now, he didn't really need anything new, as we kept all of his brother's kit. Moving house in late pregnancy also forced me to think really hard about which items I would need to hand, and which could  be stacked at the bottom of a pile of things that probably won't be sorted out until he goes to school.

I was fairly frugal with my first, being determined not to succumb to the lure of the Mothercare catalogue. Those endless checklists of "must haves" only ever seem to be written by people who make more money the more pointless gadgets you buy, in desperate hope that somehow, a nightlight with built in smoke detectors and bottle warmers will make you am adequate parent.

Despite your fears, your baby won't care whether you have the latest gadget. All a new baby needs is, well... you. Humans practise exogestation. Like kangaroos, our babies are born before they are fully developed, in other apes they would still be a foetus safely tucked away inside mum, but we have big brains, so our babies have to come out while they still fit. This gives rise to what is referred to as "the fourth trimester", a period where your baby's needs are really no more than a foetus, so for at least 3 months, all they need is food, and comfort. You can do this, no big budget required.

Oren's list.

So I was faced with considering what items Oren, my youngest son, deprived as he is, has actually used in his first 7 weeks, the list goes like this:

• Clothes, rompers and vests only. A hat and a cardi if it's cold out.
• Nappies and wipes.
• Muslin squares.
• A sling (actually, many slings, but that is my addiction, not his need)
• A place to rest when I can't hold him (like in the shower). We have a crib downstairs and a bouncy chair upstairs.
• Nursing cushion 
• Blankets
• Car seat.

A lot of this is dependent on my lifestyle however, so lets look in more detail at how this works. I am highlighting the items, in case you get bored and just wanted a list....

Sleeping

New babies do a lot of sleeping. They do like to do it near their mum though. Accepted advice is to keep your baby in your room until they are 6 months old, this reduces the SIDS risk and makes tending to them at night easier.

I, like many parents (many of whom don't talk about it) co-sleep with my babies. With my first it was upon the advice of the midwife, as he was feeding a lot at night, I was going to end up falling asleep feeding him, so best to make it safe and official. The UNICEF guide to caring for babies at night summarises the safety points to take into account. This is why poor deprived Oren doesn't have a cot or moses basket. His big brother did, he barely used it, it was a waste of space.

Cribs and moses baskets don't tend to last very long before babies outgrow them. If you buy a cot, they can stay in it for a couple of years. If you buy a cot with an adjustable mattress height (or just one the right height) and a removable side, you can fix it to your bed with bungees and there you have it, a fancy sidecar cot for easy night feeds. Second hand cots are great, but a new mattress is a must.

As for bedding you need a couple of flannel sheets, and some appropriate blankets (sleeping bags are only suitable from around 8lb upwards, they won't start kicking the sheets off for a couple of months), people tend to give blankets to babies, so you will likely end up with loads.

Clothes

When I think about buying baby clothes, I remember a conversation I overheard between a friend who was mum to a new baby, and another friend who lives a slightly unconventional self-sufficient lifestyle. The new mother complained how expensive baby clothes were, and my other friend replied that her daughter had spent her first couple of months wrapped in a sheepskin. The moral of this story is, the baby doesn't care about fashion.

A baby's requirement for clothes is simply that they need to be warm and comfortable. Sleepsuits and vests are great for this. Fancy outfits can be uncomfortable, difficult to dress them in, and it is proven (by my own research) that the nicer the outfit, the shorter it takes for it to get covered in some sort of vile secretion. A really expensive outfit will have sick applied to it as you pull it over their head. Guaranteed. Some people are a bit funny about babies wearing "pyjamas" all the time, but they sleep most of the time so why not? I certainly wouldn't want to go to bed in jeans.

From your point of view they should wash ad dry well, and do up easily. For night time, "bundlers" (long nighties with elastic or drawstring bottoms) are brilliant, because you don't have to do the popper puzzle in the dark when you are half asleep. Mothercare always stock a 2 pack of them, and they turn up in various other places too. Poppers that go straight up the front are easiest. Babies tend to object to clothes being pulled over their heads, so sleepsuits that only button at the bottom are more tricky, as are the ones that button down one side, as you have to manoeuvre a wriggly leg into the side that doesn't have poppers. 

As for quantity, you need to get enough to deal with the endless sick and nappy leakages (Our record so far is 4 outfits in a day), but remember they grow fast. When I unpacked the hand-me downs for baby number 2, I found many vests that had never been worn, as a certain number got into the wash/wear cycle, and the rest stayed fresh in the drawer. You can get away with about 10 of each (vests and sleepsuits). If you have a really bad run of laundry, you can always put them in the next size up (they really don't mind being in a big babygro) if you have those tucked away ready.

Once I caught on to how fast Nate (my eldest) was growing, I realised other babies would be much the same, many good quality, barely worn baby clothes are available on eBay and the like for very little money.

Transportation

Maternity units don't let you out with your baby without a car seat. I have yet to find out what happens if you don't have a car. Regardless of this, if you intend to take your baby in a private car, you will need an appropriate seat (you can travel without in a taxi, but if you have a portable seat and somewhere to put it at your destination, all the better). If you are planning a home birth, it is still worth getting a seat in advance, just in case you need to transfer. No one needs to be held hostage for a carseat. Second hand car seats without a known history aren't a good idea, as they lose their structural integrity in a crash. If you don't intend on using your seat in more than one car, consider a combination (stage 0/1) seat rather than a portable newborn seat as it will last longer, and tends to have a healthier seating position.

Travel systems are a cost effective way of getting a seat and an enormous pushchair. If you use buses or have limited space to store it, you may find a travel system too big when folded. If you walk everywhere and need a sturdy pushchair to put your shopping in, they are pretty good. 

Nate travelled everywhere for the first 8 months in a sling. There are a load of different kinds, a whole other post-worth, but even though Nate is a big lad, I was comfortably carrying him for a long while. I barely used my pushchair, and I could certainly have done without until he was big enough for a cheaper umbrella fold stroller. Slings are also invaluable for that fourth trimester stuff I was talking about earlier, be a kangaroo, keep your little one close to your body and your hands free. Their physiology works better, they have less reflux, learn more, become more social and are generally calmer and happier. If you wear your baby in a sling regularly, you will get stronger as they get bigger, and you will be amazed how much you can do. [I was still carrying 15kg Nate on my back, at 38 weeks pregnant]. I should add that when I say "sling" I am referring to a wrap, ring sling, or mei tai. Structured carriers that dangle the baby by their crotch (as opposed to supporting their bottom with their knees bent up) are not good for their spine or pelvis and should be avoided.

Nappies

A newborn will get through up to 10 nappies a day, so you'll need a few. Again, don't go mad bulk buying small sizes, they may grow out of them pretty fast. If you go for cloth nappies, about 20 is manageable, 40 cloth wipes will complement them. It's actually worth borrowing or buying one off samples of a few types of cloth nappies and trialling them to see which you like best. You can buy cloth nappies second hand, and often local councils have grant schemes to help with the cost. Even if you can't stomach the idea of using someone else's cloth nappies, if you keep an eye on eBay and the like, you will often find full sets going, washed, but never worn, because the parent decided to go with disposables after all. If you are going down the disposable route, you will need cotton wool and eventually disposable wipes.

Feeding

If you are breastfeeding your shopping list will be short indeed! Some people suggest having some bottles and cartons of formula around "just in case". This is generally accepted by people in the know as being something that undermines breastfeeding, and it is possible to obtain such things in an emergency pretty easily nowadays.

You will need some nursing bras, go for stretchy multi-sized ones for the first couple of weeks, then get measured for something properly supportive once your supply settles down. Cheap nursing bras are a false economy, go for the best you can afford, plus breast pads to protect them. Even nursing bras aren't essential, just a well fitting soft bra will do, but can be a bit trickier to nurse in.

I find muslin squares indispensable in the constant fight to not have vomit down my back, but some mothers don't bother. I don't understand bibs though, so it's each to their own I suppose. Muslins are massively versatile, they catch sick, wipe noses, mop up spills. They can be folded into a light nappy, or a bib, they make a good makeshift changing mat. Nate likes to put them on his head and pretend to be a ghost, or hold one in each hand and pretend to be a butterfly. Endless possibilities. In my house you are never more than a meter from a muslin; unless you have a projectile vomiting baby in your lap, then there will be none.

If you are bottle feeding you will need bottles, and some way of sterilising them, a good microwave steriliser will do bottles, pumps, dummies, anything you like. Not all babies need bottles, even if you are giving expressed or formula feeds, you can feed from a cup, or a spoon. Unless you definitely plan to use bottles, you can wait until after the birth to decide if you need them.

Nursing cushions. I am a huge fan of these, some of them cost a fortune, mine came from a supermarket and was not so bad. I used my horseshoe shaped cushion as a support during prenatal yoga, then to support my baby while he fed (they should be very firm and plump, so you can go hands free). Once they start wanting to sit propped up, it makes a nice safe comfy place for them to sit. Normal pillows or cushions can do the job, but need a big more careful arranging.

Other things that might be useful

Bouncy chairs, a decent one that reclines back and has a head support. Sometimes you need a safe place to put baby down, so you can shower. They do tend to be very expensive though, and you will only use it for a couple of months, so this is another item that is good second hand.

A bath support. My favourite was a kind of frame, with a terry covering, like a deckchair that baby lay on in the bath. You won't need it long, and you can do without, but they are useful, especially if you lack confidence or dexterity, or have a bad back.

A baby monitor. Not at all essential, especially in the early days when you will have your baby close all the time. Very useful for ordering tea when you are in bed with the baby though.

A change bag. Doesn't have to be an expensive one, just a bag that is big enough for your essentials.

Baby toiletries. A good nappy cream (I like Bepanthen, I find the old favourite, Sudocreme, a nightmare to get off skin and cloth nappies, but you get a free tub of that in your Bounty pack, so try it) and a mild baby shampoo/soap. A towel of their own (or 2) is also useful. It's worth having a mild base oil, like sweet almond oil to take care of dry skin and cradle cap.

Things that can wait until after the baby is born.

A breast pump. If you need to pump in hospital, they can lend you one. Some mothers are very happy hand expressing, or you might find you don't need to express at all, but if you do want to leave your exclusively breastfed baby for a couple of hours, or you plan to build up a freezer stash for after your return to work, a good pump is an excellent investment. If you do buy a pump you will need storage bottles or bags for the milk.

Dummies. Neither of my babies would take them. If you breastfeed it can disrupt the latch. However, if you bottle feed you may find they satisfy your baby's need to comfort-suck, and their use is linked to lower incidence of SIDS. A breastfed baby (or any baby) can be settled at the breast, they aren't "using you as a dummy", it's the other way around, the dummy is a breast substitute.

Toys. Your baby won't start interacting with objects for several weeks, they want to see people, you are their favourite plaything. After that, hanging things they can bat at are a good start.

High chair and feeding equipment. Babies don't need to start on solids until they are 6 months old, so plates, beakers, bibs, spoons and high chairs can wait.

Things you really don't need

A teddy that makes womb noises. Babies like the sound and smell of you, because they want to be close to you, with good reason. Cuddling your baby is a good excuse to rest, so why spend money on something to substitute yourself?

A bath. Tiny babies fit in a sink, or washing up bowl. Baby baths are huge to store, awkward to fill/empty and only useful for a short time.

A changing table. Are you really going to go up to the nursery every time your newborn needs a change? Even in the middle of good TV? Even when you are exhausted? In the middle of the night? You need somewhere to store your baby care items, but a basic change mat slid under the sofa, with a box/bag of nappies and wipes to hand is much handier. You can change your baby on any firm, safe surface protected with an old hand towel, muslin, or folding change mat.

Shoes. Babies' feet should not be restricted when growing. Until they are walking outside, there is no need for shoes, they are purely aesthetic, and the damn things fall off everywhere. They are very cute though, if you use them, just make sure they are roomy.

Most of the things the magazines claim are "essential" I could go on for a long while....

As I demonstrated with Oren, it's actually very possible to have a baby with very little "stuff" at all, there really is no need to panic, or feel overwhelmed, just remember that all a newborn needs is to be warm, dry, fed and loved; if you find you need anything else, you can always get it later.

Of course there is no reason not to buy everything you fancy, if you can afford it and are happy to do so; but if your little one starts life with nothing but a bag of second hand babygros to their name, there is no need to worry or feel guilty, the "stuff" is for the parents, not the baby, they will be just fine.