On turning a year old

By Anubha Rawat

I turned one year old a few months ago, a major milestone. We also celebrated my daughter’s first birthday at the same time. Turning one is such a huge developmental marker for babies that reams has been researched, written and documented about each developmental stage. However, it’s harder to find something about a mum turning a year old. The first year is intense. It’s hard on all fronts, but it’s also utterly delightful and joyous. I’ve been through this massive learning curve and am just coming out the other end. I feel like I’m just beginning to toddle, I am constantly falling and I babble a lot without making much sense! I’m sharing some of my experiences and thoughts navigating the contradictions of motherhood over the past year. I am aware I have a lot to say; it has been an epic year!

On reflection, the hilarious thing (to me now) is that I’ve actually studied child development and have over 15 years of experience in the maternal and child health space through my work in international development. As an older, first-time mother with all the knowledge and experience I’ve gained working in the field, I had this ongoing dialogue in my head that I was prepared. I knew what to expect of pregnancy, birth and the first year. As a couple, my husband and I chose to plan our family and I became pregnant with my eyes wide open (or so I thought) to the challenges that not just motherhood but parenthood would bring. Are you laughing hysterically at/with me now?

I found out I was pregnant while I was at a project site in Nepal. It was an incredible moment of such a rush of emotions and mixed feelings. It excited me that I was beyond the ‘on your marks’ stage and definitely ready to go, but at the same time it filled me with utter terror that my life was about to change in a most dramatic fashion. That day I visited a health clinic in a remote village which had been upskilled to provide antenatal care to pregnant mothers, to work with them and ensure that they and their babies didn’t end up as another statistic in the maternal and neonatal morbidity count of the country. Mums were queued up for their antenatal care visits, some having walked hours to get there. The numbers were high because this health clinic had a portable ultrasound that let them hear the baby’s heartbeat and see their tiny forms moving around. To get mums to attend antenatal care can be difficult in developing world contexts for a whole host of reasons, so this was a huge achievement. One mother was 36 weeks and advised by the maternal team to come to the clinic early and stay on till delivery due to her antenatal history that had been recorded over the past few months. Another mother was 10 weeks and the midwife sadly could not hear a heartbeat. Yet another was having her 5^th child and was stressed at the thought of feeding and providing for this child, as being a subsistence farmer it was incredibly difficult to feed her family of four already. I sat through all these consultations quietly holding my news close to my heart, by now feeling incredibly guilty because I knew how different the healthcare I could access would be.

“Nani used to say…..”

On the other end of this spectrum was my world. Indian born, I live in Australia where maternal mortality rates are one of the lowest in the world[1]. I quickly found out what a bewildering amount of information was available to me – countless books with the day-to-day development of the baby, websites with pictures of every day development and so many apps to choose from to track the growth of my baby. This is not counting the countless blogs or opinion pieces available to me at the click of a button and the schools of thought they endorsed. I would read one thing and be convinced of the way forward, then read another justifying a diametrically opposing point of view and end up utterly confused about the choices I was going to make. Either way, if I chose the other option, I would still be missing out on some sort of holy grail and in that way doing a grave injustice to my yet to be born child. The confusion and pressure that came from trying to navigate this information felt immense, I was constantly doubting myself. To add to the spaghetti in my head was my mother’s advice. Based on years of wisdom and experience passed down from my maternal grandmother to my mother, she would often say to me on our almost daily calls, ‘Nani used to say…’ It was often simple and clear advice in the sense that it was binary – I was either urged to do something, or urged not to, and there was a consequence attached to each. Some of it, of course, didn’t hold up to scrutiny based on years of research studies on various topics related to pregnancy, but some of it made perfect sense because it has worked for generation after generation of mothers. It was almost a relief to pay heed to this advice, and I gratefully adopted many of the ideas that made sense to me.

Between two worlds

In terms of global access to health care, Australia is consistently in the top 10 countries in the world[2]. Due to this wide-ranging access, almost all mothers will give birth to their babies in a hospital setting (97% in 2015)[3]. On the other hand, in the developing world where I work and where I grew up (In India 73.1% of births take place in a hospital setting[4], in Nepal 73% of births are home births[5]), we urge mothers to attend antenatal care and attend a health care setting to give birth, so there is an increased chance of both mother and baby surviving. If that is not possible, millions of dollars have been spent worldwide on training traditional birth attendants on safe birthing and importantly encouraging them to refer mothers to health care facilities as early as possible if something does go wrong. In and amongst all the information I had been sifting through, and at the opposite end of the scale of a hospital birth in a developed world context, was the idea of a home birth in a big blow up tub in a water-based environment, equivalent to a home spa, with candles, soothing music and chants to help the birth along. If you trawl through social media sites (as I obsessively did at the time), you will come across hundreds of pictures of such births with these mothers being called ‘warrior mothers’. Somehow despite low maternal mortality rates, there is an unspoken aversion to medicalised births. So women who choose pain relief, or choose to deliver their babies via C-sections, or those that end up having emergency C-sections, can be perceived as being less of a ‘warrior mother’, or can end up perceiving themselves in terms of inadequacy, failure or shame. All this confused me – should I aspire to be a ‘warrior mother’ and ditch the advice that I and my kind have been drumming into mothers’ heads in the areas I work, or should I follow my own advice and go to the hospital for the birth of my baby?!

This is what I concluded from the above – while anxiety around labour is shared amongst women around the world, I would say that it is fairly common for a woman in the developed world to sometimes experience the birth of her child as the first ever experience of a woman in labour. This can be traumatic, confusing and exhilarating in equal measure. So, in one sense, a home birth is a rebellion to the increased medicalisation of birth in the developed world, where a new mother has no control and is fearful of what the birth of her child is going to mean for her. I think this is because we have become so far removed from the natural rhythms and cycles of life, that this other way of experiencing birth is freedom from what can be perceived as a tightly controlled medical system. In many ways, the home-birth school of thought tries to normalise birth in the developed world. In the developing world, women are exposed to labour and birth from a very young age. They would have experienced births by their aunties, cousins, and maybe even their own mothers, so I believe that when it is their time, they are more aware of how to approach labour, which may mean that they don’t seek medical attention in time (along with a host of other reasons). Which is why I believe it is important to encourage women to visit a health care setting for antenatal care, labour and delivery. I am aware that I am incredibly fortunate to have had the choice!

A ‘birth plan’?

Then there was the birth plan to contend with. The birth plan is a western construct which is useful to help a couple visualise how they would like the birth of their child to go. Questions such as – do you want a vaginal birth or are you booking in your C-section? What music would you like to play while you are labouring? Do you have mantras to help you through the labour? Who are you communicating with and what will Plan B be, if well, the birth plan doesn’t work? The idea of something like a birth plan being provided to a pregnant woman who arrives at antenatal care after trekking through the mountains in Nepal, or walking through thick bush in rural Uganda seems ridiculous, but context is everything. As above, if you are experiencing childbirth pretty much for the first time, a birth plan may be useful, even if only to help assuage anxiety of an upcoming unknown, but life changing event! As long as you know that the plan is likely to be tossed out the window when labour starts. I love the way Jessica Zucker describes this monumental event in this animated series[6] – https://www.nytimes.com/2017/05/11/well/family/well-illustrated-childbirth.html

The build-up

For me, this massive and intense build-up to the birth of my child was a complete smokescreen for what was to come! Social media had got to me, and I aspired to be a ‘warrior mother’ in a hospital setting. Onset of labour was fast, contractions were 2 minutes then 1 minute apart very quickly. I moaned through every contraction with my husband rubbing my back and my mother gently pressing my feet, while I wildly inhaled nitrous oxide. I was certain I would birth her quickly. But when my little girl was born I literally forgot everything about the 19 hours of labour and the heart-dropping moments of being rushed into the theatre for an emergency C-section. In fact, I forgot everything. My heart hurt and my lungs strained at the intensity of feeling that overcame me when I heard her first big gusty cry. When I got to hold her tiny body, both of us skin to skin, she crawled towards and latched onto my breast with such determination that all the shakes I had from the medication surging through my body calmed down instantly. To me, the entire experience was miraculous. I had made this tiny perfect little human. As the oxytocin buzzed through my body, I wanted to shout out loud at the victory of it all, I most definitely felt like a warrior mother!

Anubha on way to Parents Group — On my way to the parent group

I realise that this euphoric feeling is not the same for all new mothers. Perinatal depression, which can start at any time from conception till the baby is a year old, is very real. One in seven women in Australia will experience some form of depression during this time, the scale of which can vary from mild to severe to even psychotic[7]. There have been huge public awareness campaigns about this issue and due to all the information that I had access to, I was aware that this might be a possibility for me and my family to contend with. I had talked to my mother and husband in advance, that if they saw sure signs of depression and anxiety, they would seek help straight away. In the developing world, one assumes that postnatal depression is not such a big thing, because of the way families and communities are structured, and you don’t hear much of it, because often there are other things that take priority. However, studies show that it is as prevalent if not higher than in the developed world, averaging at about 16-20%[8]. It however remains under detected and under treated and is now seen as a huge public health issue with far reaching impact on the mother, child, family and work[9].

Learning to feed

Learning how to feed my baby was an interesting and eye-opening journey in itself. ‘Breast is best’ is a slogan that is often used to encourage breastfeeding. Loads of studies show that breastfeeding is ideal for the health and development of the baby as well as the health of the mother[10]. It is no wonder it is encouraged worldwide but that doesn’t mean it’s easy or something that comes naturally to mothers! Getting my baby to latch in the correct position was a fine art and came to me after weeks of much frustration and lots of swearing. Not being housebound for a change, and for a breath of fresh air, also meant breastfeeding in public. How do you elegantly and discreetly pull your breast out and get baby to latch correctly without screaming “ouch”, all the while pretending that this is the most natural thing in the world? In the end, I did what I had to, to feed a screaming infant, but I totally understand the anxiety and stress women feel in breastfeeding in public. Then there is the issue of the woman’s body being so over sexualised, that it is inhibiting to breastfeed in public because of public disapproval. Holly McNish talks to this issue with such aching clarity in this poem called ‘Embarrassed’- https://www.youtube.com/watch?v=KiS8q_fifa0.

For women who are unable to breastfeed, or even don’t want to, baby formula is widely available. In the developed world where access to clean water and sterilisation is fairly straightforward, this is a great option to feed an infant. However, in the developing world, this gets very tricky and complex. When a mother is unable to breastfeed and the baby is put on formula, ensuring that the water is clean, the bottles are sterilised and the right amount of formula is being provided is a huge challenge. The Nestle baby milk scandal is notoriously well known in the way it marketed baby formula to poor women so much so that women were abandoning breastfeeding to bottle feed their babies with the belief that they were doing this in the best interests of the child[11]. To this day, it remains a hugely contentious issue, with President Trump stirring up controversy recently and formula companies still weighing in on these choices[12].

The baby is in charge?

Before your baby is born, it’s easy to theorise and tell yourself that you won’t put yourself in a position where the baby is in charge! You tell yourself that your baby will be different, that you will be putting the baby down and getting sleep yourself. Yes, laugh at me! This of course didn’t happen, sleep deprivation meant I was crying and irritable all of the time. In India, you bring your baby home and it’s obvious that the baby will sleep with the mother, co-sleeping is not even considered a thing to worry about. In Uganda, newborns are swaddled in blankets and sleep close to their mothers. It’s the same in Nepal and Bangladesh, and many other countries. In fact, it’s the same in Japan[13]! In Australia, I was made acutely aware of SIDS (sudden infant death syndrome) and generally mothers are discouraged from co-sleeping or bed sharing[14]. The doctors, nurses and other health care workers that I came across after the birth of Frida, all checked in to see how the baby was sleeping – swaddled, tucked in, feet at the bottom of bassinet, with nothing else in the bassinet. Literally a week after bringing her home, we realised we couldn’t do it! Frida would only be quiet when she was next to me. One morning, way too early, extremely sleep deprived, we ordered this contraption called ‘My Little Bed’ that claimed to make co-sleeping safer. It had a hard frame which made it impossible to roll onto baby, and to be doubly safe, we moved our pillows and blankets down a foot from the bedhead. I could now breastfeed comfortably through the night and fall back to sleep, not easily, but at least I was in my bed, with my little baby safe and near me as well.

Although I have to say that in the world I live in, it makes sense to have the baby sleeping separately. How else do you get food prep, laundry and all other household chores done, wake up early and function at work as well, just to repeat the whole cycle again?! There is no respite, unless you have family close by, or can afford to hire the help of babysitters/nannies. While the debate on co-sleeping can be as divisive as the breastfeeding debate, it’s again important to remember that context is everything. A year on for us, we’ve all compromised. Frida goes to bed in her cot in her room, which gives me time to do everything else I need to and much needed ‘us time’, but then she eventually ends up snuggled close to me at some point every night. I love that we’ve somehow managed to find a way to make it all work.

The new mother’s mother

What would I have done without my mother? My mother came all the way to Australia and stayed with me for 9 months, solely to look after me and her grandchild. She gently encouraged me as I laboured and after Frida was born, she mothered me as I learned to look after my little infant. Her mission was to make sure I rested and healed from childbirth. In India and in Asia, different communities have different practices of confinement, but essentially the idea is for the mother to rest and to protect the baby from infections. Generally, this is about 40 days long and is probably the only time a mother can rest and not be expected to look after her familial duties. Interestingly, in Australia the first set of vaccinations for the baby are at 6 weeks, approximately 40 days after birth. My mother had lugged home grown turmeric and semolina fried in ‘desi ghee’ amongst other ingredients to make me ‘laddoos’ which I had to eat every day. She also made me rich chicken broth, brewed herbal teas and cooked nutritious meals, all these helping with lactation and healing, giving me the energy to keep going, despite the exhaustion of the 3 hourly feeding routines. My mother taught me how to massage my tiny baby to help stimulate growth and calm her down, and she massaged my aching body as well. I cannot put in words my gratitude for this time to her. In the world I live in, 9 months of support on a 24/7 basis is extremely rare. I think she is the reason I persevered with breastfeeding and that I didn’t get postnatal depression.

Up and about

Generally, mothers are out and about as soon as possible and are often looking after their babies on their own 2 weeks after birth when their partners return to work, if they were lucky enough to get 2 weeks of leave. Parental leave is a huge issue across the world, but is talked about more in the developed world, where the voices for the rights of women are louder. The US is one of the worst countries in the developed world in that it does not mandate any maternity leave[15]. Australia is just a bit better with 12 weeks maternity leave on minimum wage. India has recently mandated 6 months of maternity leave on full pay, with an additional benefit of up to two years of child-care leave at any time until the child is 18 years of age as per the 7^th pay commission for central government employees[16]. Northern Europe has some of the best parental leave schemes available[17]. Generally, global companies do offer some form of parental leave to their employees, even in countries that don’t offer this on a national basis. Many companies and even non-profit organisations in Australia also provide additional leave for both mothers and fathers to access. We were lucky that my husband got 3 months of paid parental leave (working for QBE, a global insurance company), which meant that he was able to spend 3 months of the first year of our baby’s life bonding with, and looking after her, while I returned to work at 9 months. I believe this time has been critically important for us in cementing our bonds as a family. I have always thought paid parental leave is important, but it is crystal clear to me that it is crucial to support families as they bring up the next generation of humans, who will one day be our teachers, carers, inventors, doctors or engineers.

Community support

In Australia, soon after the birth of your baby, a midwife from the local community checks in with you within 2 weeks to see how you are settling in[18]. I found this immensely beneficial in my first year as a new parent. The midwife looks for signs of depression, anxiety in the mother and also checks in to see how feeding is going for the baby. They then assign you to a local new Parents’ group – a group of parents, (mostly mothers) who’ve had babies in the same month. This group of about 10-15 meet at the local community centre where a Nurse runs sessions for about 4 weeks on all things related to your baby – breastfeeding, sleeping, playtime, bath time etc. To me, as a first time mother, going to these sessions was invaluable. For the information, but also for the connections I was able to form with a group of new mothers. I could speak freely about the trials of breastfeeding, cry over the lack of sleep, laugh at the latest ‘poo-nami’ episode that one of us had experienced, or coo over the cute little babies. Some of us remain friends to this day and while we continue to compare notes on the development of our babies, it is also with utmost delight that we get to watch our children grow.

The partner

Having someone to share the joy and excitement of being pregnant and the terrors as well has been beyond wonderful. We both came to this phase in our life well aware of the choice we were making and spent many hours talking about what having a baby would mean for us. My partner has had to be the calm one with head firmly on his shoulders and has, like me, learned how to navigate the uncharted, ever-changing waters of the last couple of years. From making dinner for me in the first trimester, just for me to reject it after a bite, to attending every doctor’s appointment, to sitting through the antenatal classes and to rubbing my aching back in the last few weeks of pregnancy, he has done it all. Through labour he was with me for every moaning minute and was the first to see our little girl. He sees this journey as being equally owned by him. He is a devoted, besotted father to our little girl and I would say he has certainly changed as many nappies as I have, if not more! It’s hard to put in words what it’s been like having him by my side, except to say that there is no one else in the world I would do this with than him.

I soberly recognise that this is not the case for many women and children. Around 14% of the world’s children live in single-parent households, 80% of which are female led[19]. This of course varies greatly per country, but generally there are higher percentages in the developed world, than the developing world, however the numbers are larger in the developing world. We have both acknowledged this in many conversations after Frida has gone to sleep, “We’re exhausted, how do single parents do it?” We have huge respect for these parents leading and managing their families on their own.

Finding home

So, at the end of a year, how have I fared? I had knowledge (maybe even too much), the best health care services available, my mother’s unquestioning support, my husband’s presence 100% of the time, and yet it’s been all consuming, the learning curve steep. I’ve learned what love feels like in a way I didn’t understand before the birth of my daughter. I’ve felt support and camaraderie from friends and strangers on this journey of parenthood which has uplifted me on the toughest of days. It’s taught me that there is no one way to parent, to be a mother, and that’s why there is so much bewildering information out there, each experience is as unique as it is shared. I also cannot help but view the projects I work on through the lens of motherhood. I’ve felt so intensely connected to other families and parents, not just here in Australia, but around the world, in that remote mountainous community in Nepal, in the jungle bush of East Africa, a sudden realisation that we are all connected in this circle of life, cheesy as it may sound, it feels absolutely profound to me. They say it takes a village to nurture a child, but I believe it also takes a village to care for a mother. In one way or the other, navigating knowledge, cultural traditions, work experience, the politics of motherhood, questioning my own beliefs and preconceptions, and the support of family and friends, I managed to find my village.

[1] https://www.mja.com.au/journal/2016/205/8/maternal-mortality-trends-australia

[2] https://perspectives.eiu.com/sites/default/files/Globalaccesstohealthcare-3.pdf

[3] https://www.aihw.gov.au/getmedia/728e7dc2-ced6-47b7-addd-befc9d95af2d/aihw-per-91-inbrief.pdf.aspx?inline=true

[4] http://www.censusindia.gov.in/vital_statistics/SRS_Report_2012/2_At_a_glance_2012.pdf

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538619/#B10

[6] https://www.nytimes.com/2017/05/11/well/family/well-illustrated-childbirth.html

[7] https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/depression

[8] https://academic.oup.com/inthealth/article/5/1/4/698995

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160664/

[10] https://www.unicef.org.au/about-us/media/august-2017/babies-and-mothers-worldwide-failed-by-lack-of-inv

[11] https://www.businessinsider.com.au/nestles-infant-formula-scandal-2012-6?r=US&IR=T#the-baby-killer-blew-the-lid-off-the-formula-industry-in-1974-1

[12] http://www.abc.net.au/news/2018-07-19/infant-formula-breastfeeding-how-companies-influence-parents/9999452