your great life

Today I Was the Client; Self-Coaching For an Embedded Phobia

I'm going to tell you a tale of a phobia and how I benefitted from some self-coaching techniques today.  I had a procedure called arthroscopy, done under general anaesthetic, this morning to repair and clean out torn cartilage on my knee.

Most people who know me, know that I am quite phobic about needles. When my daughter was almost 4 years old, she went to my pre-natal appointments with me and held my hand during the blood tests, "so Mummy would be brave."  Sad, but true. I had many infertility examinations and one IVF cycle, so you know I've suffered through many blood tests and injections. It was a daily nightmare for a short period of time and I managed only because 1) I wanted to be pregnant so badly and 2) my father did them. For more on that, feel free to read my post from February on Injecting Fertility Medications.

What most people don't know is that my phobia is not just about needles; it's about metal piercing flesh.  When I say that, it brings to mind (mine, maybe not yours) a black & white, faux Gothic horror film with a creepy lab in the basement of an imposing mansion set back from dangerous clifftops.  I have an active imagination, but actually, that's not it. It's not about the doctor or nurse, it's not about the office or operating room. It's not about blood. It's equally bad in the dentist's chair as it is in a hospital environment. It's all about cold, shiny, sharp metal coming into contact with my skin and flesh. There's a name for it: Associative trypanophobia.

I don't remember ever feeling any other way and since childhood it has gotten worse instead of getting easier. My behaviour has improved: I no longer kick and scream. It's the anxiety that worsened and caused me to skip injections and cancel previous operations.  My symptoms, up to a week before I need a blood test or injection, include anxiety, interrupted sleep, gastric upset, dry eyes and mouth, feeling generally low and panic attacks. Far worse, though, is that I dream the same dream several times a night, in which I can hear (yes, you read that correctly) the needle or surgical tool squeaking as it pierces my skin and continues its way in to my body. Suffice it to say that I do not have pierced ears, use Botox and or ever had cosmetic surgery. No smooth neck or reshaped nose could be worth going through that unnecessarily.

Various suggestions have been made to help me through my ordeal ; some of them practical and some more cognitive.  My GP takes any opportunity she gets to give me a flu shot every Fall, when I visit for a prescription or a referral, to say, "let's get this over with right now."  That reduces my panic attack to less than 5 minutes instead of a week.  My husband has accompanied me to many procedures, held my hand through two amnioscinteses, and in one case went all the way to the operating theatre, where they hook you up to the general anaesthesia. 

What did I use to get me through my dreaded knee operation this morning?  I remembered a hint I learned from Christopher Howard's Breakthrough to Success event: "In order to decide not think of something, you have to think about it." I took it to mean that, instead of trying to go blank, I needed to fill my mind with other thoughts.  This is what I did for a few days before and in the hospital:

1. My father recommended traditional meditation, so in my hospital room, I sat in the tall-backed armchair, relaxed all of my muscles from the toes up, and filled my head with a sound variation of the garden-variety "Ohhhhm." I did my funny trick, for insomnia, of imagining I can see with my eyes closed and focused on the floating colours.  Anyway, it blocked out the images of a needle the size of an exhaust pipe trying to go in my arm.
2. I was interrupted a few times during that first hour, so each time I resettled myself, I did some EFT (tapping 9 meridian points on your body, that create an emotional response and healing), which has been described as a kind of mind+body treatment together with acupuncture principles.  My EFT statements this week have included:
3. • "even though I'm afraid of needles;
   • "even though I believe I can hear the needles and surgical tools in my body;"
   • "even though I am most fearful of the anaesthetic needle;"
   • "even though I won't be in control once I am under anaesthetic;"and
   • "even though I fear having this operation , ...."I deeply and completely love and accept myself."
4. Finally, I did some NLP-type visualisation, taking my nightmare vision of the enormous needle and tube attached to the drug and fluid drips and shrinking it down to the size of a toast corner. I then threw the toast crumb and it became a sandy beach which grew until I could see myself on the deck of my dream beach-house, surrounded by blue sky, sun and sea.

What helped:  Well, I want to be completely honest here. It was a case of all and none. This morning, I asked my husband drop me at the door of the hospital at 6:45 a.m. and had a little over an hour by myself. So, the meditating kept me centred and tranquil instead of pacing and biting my fingernails.  The EFT took me back into myself when the nurse and anaesthetist left my room. My difficulty (I am a self-trained beginner) was that even though I did it repeatedly, and tried to use each of the statements above, I kept coming back to "Even though I am afraid of needles..."

The visualisation worked to focus me on a specific, happy image of my future life and it came through strong and clear. However, it had a fault: it kept going in and out like an instant rewind and playback. I heard the anaesthetist and nurse talking about my veins and tapping on my hand and my vision shrunk again. I kept mentally pushing it back in place and that was the last image in my head when the anaesthetic took hold and sent me to sleep.

What I got from this: With each of these three methods above, I can subdue my fear and relax myself from a panic attack, for brief periods of time. With more practice, I am sure that I could lengthen my relaxed state. Possibly, the most important benefit is knowing that I can do this on my own, instead of relying upon someone to go to the hospital with me and/or take a chemical relaxant. I felt scared beforehand and empowered afterward. I believe I will have more confidence in a similar situation if there is one. That's positive enough to inspire me to study EFT and meditation further.

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Do you have a phobia or know someone who does? Here is my List of Do's and Don'ts for anyone who knows of it. Print it out and give it to someone who is on your/their support team.

A List of Don'ts:

• Don't call a child or adult who suffers from a phobia, a baby. Teasing is cruel and makes a person feel ashamed.
• Don't tell them to "grow up." Maturity had little/nothing to do with phobias.
• Understand that no one wants an aspect of their life to be limited by their phobia. It isn't necessarily a choice, even though they can choose to seek treatment for it.
• It doesn't help them to hear how "so-and-so had this only last week and it was fine. What are you worried about?"
• Do not tell a phobic person that "it's all in your head." The irrational side of them can't process that information while they are in it.

A List of Do's

• Express understanding that she has the phobia. (even if you don't understand why she has it).
• Ask her how you can be of help, such as staying with her, holding her hand, staying silent, etc... (If she is very agitated, she may get upset and say: "Nothing will help!" This is not a rejection of you.)
• If she finds a self-coaching technique she wants to try ahead of time, allow her to practice on you and vice-versa.
• Boost her self-confidence by reminding her of other obstacles she has overcome.
• Allow her to talk it out, if that helps her keep calm, even if you have heard it all before.
• Make sure that she does not base her self-worth upon the negative feelings she may have about her phobic self.

She's Pregnant and You Blog-Hate Her

Oh, the wonder of social media. In blogs, infertile women can spew bitterness about women who are pregnant or who have young children, whether they are known or strangers. Previously infertile women like me can blog back about what they have learned from their experiences. 

I know, firsthand, how insensitive people can be in their attitudes, comments or behaviour around infertile women.  There will always be those people; some of them literally thoughtless, others purposely mean. I also understand jealousy.  Jealousy of friends who had conceived immediately. Jealousy of women who had never suffered the loss of a baby. Jealousy of women pushing Bugaboo strollers. Jealousy of friends who had cappuccinos in the park while their second children played together. Jealousy of people who were happy on my miserable days. 

What I never felt, and really don't like, is the venom I've read in some blogs toward other women who are fortunate enough to have a healthy reproductive system.  Pregnant women have been verbally attacked as smug, undeserving and inconsiderate just for being pregnant.  How dare they be in our workplace, at our family get-togethers, among our group of friends or walking our city streets?  The irony is that if the writer became pregnant, she would be beaming with joy and bitterly resented by another woman who doesn't know her story. It disturbs me that women commenting on these nasty blog posts back up the blogger like an angry mob at a lynching.

Infertility is a high-emotion, intensely personal topic, status, challenge and condition. There's the fantasy of becoming pregnant, the identification of her fertility with her womanhood, her importance, femininity, desirability to men and her purpose. Infertile women shoulder a lot of confusion and pain.  Some can dig deep to find inner strength, look for and accept support and work hard at keeping perspective and balance.  They eventually understand that even though it's personal, infertility doesn't choose one woman because she is judged bad, or skip by another woman because she is good. No one deserves infertility or miscarriage. 

So, why the bitchiness and the eagerness to be on her side? Is it like the old saying "misery loves company?" Does anyone really think that playing the "yes"(wo)man is helping in any way? I hope not. All it does is give the speaker permission to keep going in this way.  I understand the temptation, when a woman has an audience and the advantage of relative anonymity, to mouth off, but it does you no favours:

• If it's not real, it's not right;
• It's not good karma;
• It doesn't improve your chances of conceiving;
• It doesn't make you new "quality" friends;
• It uses up mental energy you could be putting toward your own goals;
• It interferes with you mind+body connection;
• It could actually hurt someone;
• even if people laugh or point with you, that's not true support;
• it's an attitude and behaviour that is beneath the "real" you;
• it's more difficult to move forward when you're carrying the burden of resentment.

Can you possibly be in the best spirit and fitness to conceive the baby of your dreams, if you are carrying around intensely negative emotional baggage? No, you cannot.  It requires diverting some of your precious focus, commitment and energy from your goal to the attention you pay in thinking about, talking about and storing up emotion towared that other person. It creates stress in your system that you could really do without. You could be turning off the friends to whom you blow off steam, who may not comment in the face of your vehement anger, but won't think better of you.  It does absolutely nothing good for you and your future baby.  While you are trying to conceive, anything that doesn't relax you, educate you, nurture you or progress you, would be best banished.

Think of one woman who really ticks you off, whether it's for something she has said or done, or just because she breathes the same air as you. (I'm trying to be non-judgmental of your hatred.) On a piece of paper, make 5 columns across the top and label them, left to right, the person's name, what they do or did that upsets you, how you categorize your feelings toward that person:

• hurt
• anger
• jealousy
• disgust
• guilt
• selfishness
• blame
• just had the good luck to be pregnant, and so on.

Then, in the next column, what your part is in this relationship or scenario, possibly:

• blameless
• equally at fault
• wished her to lose what she has
• started the bad vibe
• never gave her a chance
• don't like the look of her, etc...

In the last column, if you can be honest with yourself, what could you do to get rid of those feelings you hold about her that are weighing you down? Do you need to make an apology, explain what has upset you, release your negative feelings toward her, start talking and/or acting differently toward her to smooth things over or just forgive her for whatever wrong she has committed?

If you are the friend of someone who has been acting this way about someone else who doesn't deserve it, think twice about agreeing with her just to make her feel better. It could break up your social group. It could dominate all of your conversations as your friend carries on obsessively. It could just make you feel bad. It won't help her get pregnant.  Suggest that she talk it out, write it out or get some coaching.  Appeal to her better nature and distract her toward more positive thinking. That is what support is all about.

The Trouble with Mothers and Daughters - How to Improve It

Never mind Sex Ed 101 at school.  Who did you turn to in confusion over your maturing body, practical information, tears over a broken heart, access to medical, well-woman checks, guidance about balancing sexual curiosity with sensibility, contraception, protection against pregnancy, wanting to conceive, and guidance through pregnancy, infertility or miscarriage?  Your answer will depend upon your mother's comfort with the subject, the generation in which you grew up, your religious background and beliefs and the relationship you had with your mother.

What experience do you want for your daughter?  Your relationship was so sweet and uncomplicated when she wasy very young, but now it is often complex, confusing and sad.  If it's your intention to be there for her, but something stops you short every time you think you should step in, you need help.  

If you are having difficulty communicating with your adolescent or teenage daughter, it's time to try and breach the gap between you.  Left to fester for too long, it could be a missed opportunity that will end up in a split when she is old enough to leave home.  Don't let it reach that point. It's never too early to act in order to recover the bond between the two of you. 

• The first step is to let her know that you are troubled about the way things have been going and that you want change for the better.
• Second is to agree to disagree. Depending upon how bad your relationship has been lately, your daughter may be wary.  The two of you only have to agree to take action in order to make things better. Everything else can be the subject of conversation and examination.

Frequently heard (or thought) by Mom (M) and/or Daughter (D)

(M) + (D) She doesn't understand me. 

(M) If she thinks I'm old and "past it," maybe other people do too.

(D) You're only saying that because you're my mother and you're supposed to say that.

(D) It's not fair!

(D) I can't tell Mom what I have learned or experienced.  She would (pick one: disapprove, think I'm bad, punish me severely or not love me anymore).

(M) + (D) How can I trust you?

(M) She doesn't respect me.

Do you recognize anyone here?  You love her, but frankly, she's been challenging lately, unpleasant to be around and suspicious of your motives.   She loves you, but you have been grumpy, quick to criticize and untrusting. In many cases, there are two people on opposite sides of a glass wall, wishing to make amends but scared to make the first move.  Pride gets in the way. So do hormones. Your daughter's moods that seem irrational and overly dramatic (even hysterical), as well as what seems some very late mornings, can be a result of puberty, her period or the rate at which she is growing. Your lack of patience, occasionally sharp voice or forgetfulness can be related to your own hormonal fluctuations, especially if you are in peri-menopause (reportedly, up to about 7 years before being classified as menopausal.)

It can get much worse than that if it goes on too long, when desire to make amends and show love is less, relative to her desire for peer approval and your desire for an easier life without these clashes.  We want to get in there before reaching that stage, to prevent estrangement and ensure there are no regrets.

While engaged almost entirely with fertility and family-building issues lately, I began to think about my self-prescribed remit: to educate, motivate and support people regarding their reproductive health and creating families. This runs from newfound fertility as in menstruation and the loss of fertility, as in menopause.  However, as I thought about the sources of some women's emotional blocks to conception, it dawned on me that this included those having fertility-related trouble within families too.  How a girl feels about becoming a woman, how she feels about her body, and her ideas about pregnancy and childbirth can be influenced by what she knows about her mother's body image and fertility history.  For both woman and girl, this includes:

• how she first experienced menstruation;
• how (and if!) her mother taught her about her body;
• how a girl observed her mother's treatment of her own body; and
• what a girl was told or overheard about her anatomy, her reproductive system, sex, birth control, pregnancy, childbirth  and mothering.

A healthy relationship between mother and daughter during these formative years is very important to both of them.  It's not a one-way street. Their feelings about themselves depend in part on the love and approval of the other.  While a teen may feel misunderstood, angry or never good enough for her mother, a woman might feel she is failing as a mother, leading to low self-esteem and embarrassment. Mom may understand part of what her daughter is feeling, if she is observant, but most daughters don't have a clue about what Mom might be going through.  They can't read minds; younger women need to be informed.

It crossed my mind that there is no reason that a mother and daughter couldn't come to me for "couples" coaching sessions. While I would be happy to coach either Mom or Daughter (but not both, separately), I see the potential for much quicker change and lasting benefits to them being coached together. I began writing a program for a Mother-Daughter Workshop that will begin in a few weeks and hope to get some of my "ideal" clients involved; those on opposite sides of the glass wall, looking for a way to get through to the other side. 

This will work for a variety of relationships, not just a traditional mother/daughter one, and for all sorts of scenarios.  So, if you have or know someone who has:

• a tenuous relationship with your own daughter;
• discomfort talking about the body, sex and/or reproductive health;
• a girl being raised by a female relative, friend or stepmother; or
• a girl who is being raised by her father and doesn't have adequate maternal figures in her life.

Wouldn't it be good for someone trustworthy to step in and provide that safe place in which thoughts, feelings and questions can be aired and answered?  Ultimately, she may need a deeper level of understanding and support than you can provide.  Equally, you may want to show her who you really are as a woman and as a mother.  You could both break through misconceptions and unhelpful, self-imposed rules about discussing emotional subjects, intimate parts of the body, fertility or sex. I am designing a loosely structured coaching program as a platform that will then be customized to both your needs. Expect to actively participate in supervised conversations, revealing activities and some fun for you and your daughter. The benefits of Mother-Daughter Coaching include :

• better communication;
• values assessment;
• breaking down "emotional" walls between you;
• clearing up misconceptions you each hold about the other;
• building empathy;  and
• building trust.

Call Now to arrange your Mother/Daughter sessions at Stanmore Chiropractic Clinic at 020 8954 8311. 

For information about the 4-session Mother/Daughter Group Workshop: email lisa@yourgreatlife.co.uk  Dates, venue and fees - TBA. 

Period, Curse, Hell. How Hard is it to Talk About Menstruation with Your Daughter?

Following on from my post about mothers and their adolescent or teenage daughters, I want to look at how we introduce and embed attitudes in our girls toward their changing bodies. Discussion about a girl's body should start just before or around the time that a girl is going through puberty, noticing the beginnings of breasts, body hair and menstruation.  Some girls learn what they need to know from their mother, while others get information in bits from girls at school, camp or at sleepovers.  It can be a confusing time. How they are introduced to these subjects as adolescents can have a lasting effect on their attitude and self-image throughout their life.

If a girl isn't encouraged by her mother to learn about what her body looks like, how it feels and functions, she may think that it's a taboo subject they can't discuss, question or explore.  I feel very strongly that this knowledge is necessary to build:

• a positive and healthy identity,
• a keen awareness of her personal hygiene and reproductive health, and
• ammunition against social myths and antiquated ideas about a woman's mental and physical capabilities.

I have no problem with primary schools giving a class about sex and procreation, providing that it's presented in a fairly neutral way regarding values. In fact, I wrote a blog article last month about making sex-ed classes compulsary on a continuing basis, both through the Education Authority and the Health Service as a way of preventing infertility and applying equally to unwanted pregnancy and sexually-transmitted disease. Ultimately, though, I believe it's a parent's responsibility to teach his/her children about gender, their bodies, sex, pregnancy and childbirth at home, preferably in advance of the Sex Ed class. 

I realize that some parents may have had experiences and attitudes drilled into them that make this a really uncomfortable subject to discuss.  In that case, 

• prepare a brief talk in advance,
• be honest that you feel uncomfortable but that it's important,
• buy a book that will help you explain it or
• ask someone who is informed and sensitive to introduce the subject to the child and even act as a confidante.

For instance, let's start with menstruation. The period. That time of the month. The curse. A nightmare. It's rarely talked about in positive terms.  A particularly offensive term used is "on the rag," referring to a sanitary pad or to the cloth rags used to soak up menstrual blood in past generations. It's a derogatory term that sounds filthy and is meant to convey that the woman is acting bitchy as a result of her period.  It's just as bad for a male classmate or colleague to dismiss a woman as ditzy, hysterical or abnormally  forgetful while menstruating.  A more playful term used these days is "Auntie Flo has come to visit," which seems obvious now relating to menstrual flow, but which confused me for a good while. "How many women had an aunt named Flo?"

What's a young girl to think or feel about getting her period once she's exposed to these attitudes?  It's fair to say that she will feel negative, embarrassed or even ashamed. At best, menstruating is seen as inconvenient.  Not many girls would say that her period makes her feel womanly, proud or in possession of a new power: to become pregnant and have children. That may come later, when her figure has changed more fully and is the focus of positive attention and she has matured emotionally and can put 2 + 2 together.

PMS (aka premenstrual syndrome, premenstrual tension, PMT) can also affect a girl's feelings about her body. The physical symptoms of menstruation can range widely from light to extremely heavy flow of blood or very mild to excruciating cramping, and possible including lower back pain, headaches, breast tenderness, water retention and gastro-intestinal responses like diarrhea or constipation. Some women feel depressed, while others have mood swings. These symptoms, singly or in combination with others, can signal the onset of a period for some women or last all the way through. 

Because one woman's mild discomfort during a period can be worlds away from the incapacitating pain to another, family and friends might think a girl is exaggerating her PMS and not take her seriously, or even make fun of her. Feeling misunderstood or uncared for, in addition to the menstrual symptoms she feels, could make a girl feel depressed and ostracized. If Mom does that, it could be hurtful enough that it breaks down trust and drives a wedge between them. A girl may then turn to other people, like a school nurse, a friend or a friend's mother for information, understanding and comfort from that point on.  It could be enough just to show that you are there to listen and help if you can.

What you can do for your daughter:

• Open the topic. If she hasn't yet had her first period, ask her whether any of her classmates have started.  If she isn't sure, ask her if she feels ready to learn about it. Even if she says no right then, she may have second thoughts and come back because you have shown that it's alright to have that conversation.
• Once your daughter is ready to talk about how her body is changing and what lies ahead, explain why menstruation occurs.  If you aren't sure  you know all the facts, ask your doctor for a leaflet or a referral to a gynaecologist.  There are books aimed at her age group that describes it carefully and sensitively. A more technical book aimed at adults is Our Bodies, Ourselves For the New Century by The Boston Women's Health Book Collective. My 1998 version is well-thumbed and highlighted. * I would not suggest you send her to Google or any other internet search to discover these facts by herself. Images can appear on screen that would be inappropriate or scary to a young girl.
• I've written a blog article about the importance of knowing about your own female bits, that's just as relevant for young girls as it is for a woman of any age who hasn't had sufficient curiosity (or courage?) to take a peek. If you spent half your life ignorant about what organs are between your thighs and how they work, I suggest you follow the instructions here.
• Do not describe a period as an illness or as dirty. It's a natural bodily function for a healthy female during her fertile years.  (There are religious and ethnic communities that segregate women during their period, implying that a woman is unclean or unworthy of being with men while menstruation.  If you belong to one of them, you probably won't appreciate my belief that these societal restrictions were created by men to control women.)
• A pre-existing negative perception of menstruation can influence a girl's experience, even if her period turns out to be relatively easy.  These beliefs can be turned around in coaching sessions, but isn't it better to prevent them?
• Talk about hygiene related to her period.  Buy some youth-sized panty liners, feminine hygiene wet wipes and some thicker sanitary napkins for heavy flow and nighttime wear.  You can also buy a pack of tampons for her to try later on. Open them up, show her how to use the pads and agree where they will be kept in case she gets her period for the first time when you aren't home.
• Reassure her that she will be able to function normally during a period, including; going to school, exercising, socializing and swimming.

Set the stage for good communication between you and your daughter for the future. Make an effort to be informative and caring, rather than force-feeding this information before she is ready. You will know your own daughter, but you may have to be really observant around this time so you don't miss the boat.  If you do find that she has already been given some of the information by others, ask her what she knows so you can confirm or correct it.

Finally, if you feel disturbed that your daughter reaching this stage in her development, it's important to discover the source of your discomfort, because it may be more about the changes in your own body. If your hormones are fluctuating, your breasts are sagging and your self-image has taken a hit, it would be understandable that you are ambivalent about having a maturing, nubile daughter.  The tension in you can be misunderstood by your daughter as rejection. It may be time for a Well-Women health check.  It may also pay to discuss your feelings about aging with your daughter, but be very careful not to make it sound as though she has done anything to bring this on. 

Fertility coaching can help you improve strain between mother and daughter, arising from any of the fertility stages such as menstruation, TTC, pregnancy, miscarriage assisted conception or menopause.  Issues such as communication, trust, commitment to the relationship, fear of the unknown and values weave their way in and around this part of womanhood that both mother and daughter will pass through.  If you are experiencing difficulty coping with your body image or function, or your daughter (or mother) is, contact me at lisa@yourgreatlife.co.uk for information about being coached. I work with clients in person or via telephone sessions, internationally.

Mother and Daughter - Getting to Know You

I've been thinking a lot about mothers and daughters lately. All sorts of thoughts have been running through my mind about how notoriously difficult their relationships can be around the time when a daughter gets her period, her figure and her desire to be "grown up." I'm a little premature in wondering what will be when my daughter reaches that age, so I've been asking around.  Where do the difficulties arise?

A girl who is between 12 and 17 years old and in secondary school, is discovering a whole new world. She may know virtually nothing about hormones and how they are influencing her physical changes, her thinking, moods and feelings.  She just knows that her world is topsy-turvy. Some girls take to early womanhood as if they were made for it, if you know what I mean. It takes others a little while longer to figure it all out.  It's unpredictable and it makes for a lot of drama.

Now, add Mom to the equation. These days there's no "normal" age gap between mothers and daughters, so consider that mothers will be anywhere from 20 to 40 years older than their daughters.  On the young side, Mom may be in their mid-30's when Daughter starts experiencing both the confusion and the power of her fertility and early sexuality. Whether it's all gawky limbs, pimples and PMS or perky breasts, cute teenage underwear sets and legs up to there, it requires adjustment, not just on a girl's part, but also on her Mom's.  Is she going to feel ill-equipped to deal with new questions and behaviour? Is she going to say all the right things to reassure and empower her daughter to grow into her new persona? Is Mom going to feel an irrational threat of competition with her own daughter? 

On the other extreme, there is the older Mom.  Now that many women are having natural or assisted pregnancies in their 40's, won't be that unusual for a mother in her mid-50's to have a teenage daughter.  Mom is likely to be experiencing, or have experienced, menopause at that time.  She has lost her fertility at the same time, roughly, that her daughter is coming into her own.  Mom may be older and wiser, more able to cope with her daughter's rollercoaster moods, questions about sex, but could also feel unsettling jealous feelings. 

In both these scenarios, Mom can feel a real sense of loss that her baby has now grown up.  The kisses and cuddles, wanting to spend time together and open conversations can be replaced by closed bedroom doors, more value placed on her friends' opinions than on her parent's and a language all her own. This is all natural. Depending upon how Mom reacts, the awkward times will eventually work their way out and they will form a new mother/daughter relationship that can give them both what they want and need from each other. Depending upon Mom's openness about her own reproductive health and feelings about ageing, their relationship can remain close and supportive as they both experience change.

Some of the issues that can arise between adolescent - teenage daughters and their mothers are:

• menstruation - fertility, discomfort, "womanhood," embarrassment, self-care
• privacy - bathing and dressing, diaries, telephone calls
• communication
• lecturing
• expectations
• approval/disapproval
• rules, independence
• hygeine, self-care
• dating
• sex (values, danger of STD's, threat of pregnancy)
• birth control (sanctioned or obtained independently)
• femininity
• attractiveness
• competition
• fear - wanting to protect her against hurt, injury or danger
• taking sides in conversations and arguments with father

A lot of these are matters of perception rather than reality, but unless mother and daughter are communicating well, it can be difficult to determine what is true or false.  It's not all about Mom staying one step ahead of her daughter and making all the changes herself.   It requires a girl to see her mother, perhaps for the first time, as a woman with a life of her own.  It requires a mother, no matter how well-intentioned, to withhold opinions so that her daughter can form her own.

This is an emotional time between mother and daughter that can be eased with the help of coaching.  I am developing a program that will give mother and daughter every opportunity to see the other's experience as valid for them, empathize and support each other.  As a non-judgmental third party, I can guide them to voice their questions, feelings and experiences in a way that they may find impossible to do on their own. I'm really looking forward to helping girls and women understand and appreciate each other. 

What are or were your experiences with your mother and/or daughter? I would love to know what you think.

A Little Late, But I Made It - Welcome ICLW

I was halfway through my chosen blogs for the first evening of March's ICLW before I realized that I hadn't posted anything on my own blog today to welcome you. Sorry for the faux pas, and welcome. I love reading your blogs and hope you will love mine.

I'm Lisa, the mother of two children who seem to be growing up in triple-time. As proud as I am of my 10 year old daughter and my 6 year old son, I can't help but think that I miss their 2 or 3 year old selves sometimes. I'm not broody, and thank God for that, because it's extremely unlikely I would be able to have another child now anyway.  Having Honey and Pip seemed miracles enough, coming between and after 4 miscarriages, a few years of secondary infertility and an unsuccessful IVF cycle.  When Pip was just 3 years old, I started experiencing symptoms of peri-menopause; several months at a time without a period, then a hell-ish one, insomnia and hot flashes, repeat, repeat, repeat.  Most of the other mothers dropping off at nursery school had a younger one too or were contemplating whether to have another child.

I'm a fertility coach, working with issues ranging from uncivilized PMS to stressful fertility treatment, heartbreaking miscarriages to confidence-stripping menopause.  Through Your Great Life, I'm about to launch a series of hands-on workshops introducing infertile women and/or men to a variety of supportive complementary therapies, as well as a mother/daughter fertility workshop.  At the same time, roughly, that I trained as a coach, I also trained and began working as a helpline volunteer for the Miscarriage Association, a UK charity that provides support for anyone suffering from pregnancy loss. I now run the North London Miscarriage Support Group, a free monthly meeting that enables women who have experienced similar experiences, and their husbands, to share information and support in a safe, positive environment.

Some of you will know that I am also the fertility coach for Circle + Bloom. I'm delighted to be associated with Joanne Verkuilen and Susan Cooke; the producers of wonderful relaxation audio programs aimed at improving the chance of conception, the success of IVF, the pregnancy experience and, even one for a chilled-out husband.  I wish that my husband Brian and I had had such informative, sensible and relaxation-inducing sessions during our own years trying to conceive. If any of you plan to purchase The Complete Fertility Package for yourself or a friend, you will be offered a coaching session with me as one of the perks. I hope you will take us up on it.

I really appreciate comments on my blog.  They help me learn and laugh.  Please have a go.

Lisa

BTW, I'm an American Jersey-Girl, living in London for 15 years!

The Implications of Obesity in Pregnancy and Its Costs

The implications of obesity as it relates to pregnancy and childbirth are many. Obese women may have health issues that predate conception, such as having a greater chance of high blood pressure and heart attack.  BBC News has reported today the findings of the Centre for Maternal and Child Enquiries (CMACE) that obese women are under-served by the NHS hospital ante-natal and maternity units. 

Obesity is the next step up on Body Mass Index (BMI) charts from "overweight,"  having a score of 30 - 32; morbidly obese at 33 and upward. Once pregnant, an obese woman present a higher than average health risk to herself and to her fetus, including gestational diabetes, pre-eclampsia and stillbirths.  However, there are financial implications too, as they require hospitals to cater to special needs, including extra-wide operating tables, beds and staff on hand. According to CMACE findings, only half of the 320 units examined regularly assessed the extra support and services and equipment an obese woman may need.

Obesity is a growing health problem in the UK, as 20% of pregnant women are said to be obese.  This brings up the issue of self-determination, confused by the right and ability of a national health service to control their use of public funds. 

• Is obesity a personal issue or a nation-wide trend?
• Is obesity so common now that it is considered a medical condition?
• Can the NHS effectively turn the trend around by stepping up and offering more information, guidance and treatment for obesity beginning in adolescence?
• Would earlier monitoring and treatment, as above, be more cost-effective than special treatment for obese women in pregnancy?
• Assuming that a pregnant woman has the right to be treated for maternity under the NHS regardless of her size and weight, could she be simultaneously required to enroll in a nutritional and fitness program in order to lose some of the weight?
• Should the onus of responsibility for a woman's pregnancy health rest with her, her GP or the Ante-Natal supervisory team at the hospital? By two of these, or all three?

Obesity is not a new issue, relative to maternity. In January, I wrote about guidelines suggested by the  European Society of Human Reproduction and Embryology (ESHRE) that would have fertility clinics turning down obese women for IVF if they refused to make positive lifestyle choices in regard to weight (also alcohol and cigarette smoking).  This topic didn't seem to get much press attention or many comments on social media like Twitter, or on my blog.  However, combined with the CMACE findings, it presents a picture of obesity in the female population of the UK and far-reaching effects: 

• Elevated levels of childhood obesity, due to overeating and under-exercising;
• eating as a lifestyle choice (social gathering, entertainment, boredom), rather than from a nutritional perspective;
• earlier onset of menstruation than in previous generations;
• a lack of education, during adolescence and young adulthood on the health benefits of achieving a weight in the "normal" BMI range;
• higher-than-ideal weight beginning in young adulthood due to poor eating habits;
• a fast-food culture that has overtaken family meals around the breakfast or dinner table;
• ignorance of the detrimental effects obesity could have on them and their baby;
• inadequate supervision of a woman's weight gain during pregnancy (It's been many years, however, I distinctly remember asking why I wasn't weighed in the ante-natal clinic. I was told it was no longer policy to weigh pregnant women after the first intake.);
• Inadequate measures and/or equipment in hospital to cope with problems related to a pregnant woman's obesity; and
• no follow-up with a woman after her baby's birth to ensure that she lose that extra weight before trying to conceive again.

In a country that does not have a national health service, it would be almost, if not totally, impossible to create a nationwide scheme to reverse the ever-growing trend toward obesity. Since the UK is under that system, it seems like new measures should be put in place now.  We know that the onset of menstruation is linked to a girl's weight. A girl needs to have reached what is called the critical weight, approximately 45kg (101 pounds), before menstruating begins. Girls who are moderately obese, start menstruating earlier.  That mothers are on alert these days for their daughter's first period, beginning at age 9/10 (School Year 5 in the UK), is indicative of the average girl's weight reaching 45kg earlier in her life. 

Were GP surgeries to provide girls of age 8 or 9 years and their mothers with access to workshops, leaflets of information about their bodies and imminent changes they will experience,  suggestions of healthy weight ranges, a balanced diet and the benefits of exercise, it could reduce the number of girls entering teen years and obesity simultaneously.

It's not such a radical idea. We already get reminders from the local Health Authority of the vaccinations that are directed specifically to higher than average incidents of particular diseases in a particular area.  If cost is the issue (and when isn't it?), I have a few thoughts:

1. institute the program through the health visitor scheme, inviting every girl in the patient database in for a group talk every year or two;
2. send trained health workers into primary and secondary schools, rather than using the teachers; and
3. perhaps most radical:

• when a female patient notifies her GP of her pregnancy, she should be weighed at the surgery. 
• Her ante-natal care should then include a nutritional plan appropriate to both her BMI and her pregnancy and help with implementing it.
• Supervision - If she is weighed at every ante-natal appointment, someone at the surgery can help her keep her weight gain to a minimum.
• She should be offered some sort of behavioural therapy, whether CBT, NLP or other coaching or counseling help.
• The GP should then notify the hospital ante-natal department of the need for special measures as applicable.

Even a small, positive change could make a difference within the generation of women who are of child-bearing age right now, but certainly within the generation of girls being born now.

Complementary Therapies under Attack

This week there has been quite a lot of attention paid to two of the most popular complementary therapies: massage and acupuncture.  However, rather than singing their praises, two teams of researchers have revealed results of their separate studies, that show they are not effective as claimed. Specifically, researchers claim that Breathing 'as Good as Massage,' and Acupuncture 'does not aid fertility treatment.'

How do you feel during and after a massage? Imagine your stress, whether from work conditions, relationships or infertility, making you feel really uptight.  You enter a quiet room with no distractions.  Using warm oil and possibly lovely scent,  a massage therapist slowly kneads away your knotted muscles, releasing the tension in your neck, arms, hands, back...  That feels really good. Many people end up so relaxed from a massage that they don't feel confident driving afterwards; hence the mobile massage therapist who brings the folding bed to your home. Absolute indulgence. 

However, the results of a research study in the U.S. with people who had generalised anxiety disorder, showed that three different types of relaxation treatment, all given in softly lit rooms with quiet music, had virtually the same effect.  The three treatments were deep breathing, thermotherapy (warming their arms and legs) and massage.  The study concluded that deep breathing was just as good as and much more cost-effective than massage.  Perhaps the power of massage is partially due to the pleasure it gives; lying on your back and breathing deeply cannot claim to do that.

The British Fertility Society's review of acupuncture showed that there was no significant effect on the rate of birth, pregnancy or miscarriage.  "There was currently no evidence that acupuncture aided fertility treatment" or Chinese herbal remedies. Prof Edzard Ernst is reported as saying "This will help infertile women not to waste their money." That's quite a strong statement.  I welcome comments from acupuncturists and their clients on this.

I am neither an acupuncturist, nor a massage therapist. I have never had acupuncture. I have had many massages, which if the therapist is very good, is my idea of heaven. It not only unknots spots of tension and pain in my neck and lower back, but also seems to clear my head. In order to give myself over to the massage, I deliberately let go of anything that is troubling or cluttering my mind. Other people find that massage helps them release emotion that has blocked their progress in a particular area.  If your neck is stiff when you arrive, not only will the pain go, but also the stress that has caused it can be released and the emotion behind that stress is able to be recognized.  Since stress can impede healing, it stands to reason that the release of that stress can assist healing.  If someone gets great benefit from that therapy, who are we to tell them it isn't so?

I'm more concerned about the Acupuncture study.  I don't know whether acupuncture treatment, with or without accompanying Chinese herbs, on its own could aid fertility treatment. I would never suggest that a woman give her infertility treatment over completely to an acupuncturist.  The reason is 1) my lack of medical knowledge and 2) the woman may, depending upon her age or other condition, lose valuable ovulating time. However, many women swear by acupuncture as an aid to fertility treatment and I accept their opinion. 

Each woman has a choice of which treatments to pursue and they have to balance the treatment, the cost, their beliefs, and the beliefs of their doctor and the window of opportunity in which to conceive.  I guess what I'm saying is if you have little time to waste and believe acupuncture may help, go for it.  Look for a reputable practitioner who can give you references and ask specific questions about what the benefits will be to you. You may even get a recommendation from your doctor. 

Self-care is an extremely important piece of the puzzle whether you are dealing with physical or emotional health.  When I work with clients on their self-care plan, I recommend that they do their own research as to what can support them in their pursuit of conception or any other goal.  It has to be your choice.  If you decide to go ahead with massage therapy and/or acupuncture, go into it with an open mind and no expectations. If you feel positive results, keep it up. If you don't receive any positive results after a few appointments, and can't sustain that open-mindedness, then call it quits.  Testing something out that may or may not work, is better than looking back with regret and wishing you had.

Coping with Infertility on Mother's Day

It seems wrong to write about Mother's Day in a blog that's readership includes more than a few infertile women, however, it brings up memories of past years and how painful they were for me. You can't go grocery shopping without the "holiday" being shoved down your throat.  The flower stand is 3 times bigger than usual.  Special meals are being offered. One supermaket is selling a meal for 4 for £15.  Cards, gifts, flowers, meals; Mother's Day is everywhere.

My best way of coping, by far, was getting stuck into a project or task without coming up for air until the next morning. Have a focus, all planned ahead of time; or at least, before getting out of bed. I have a few suggestions:

• If you have an attic, basement or garage, embark on a de-cluttering and cleaning project that will take all day;
• Bake. All day. Baking takes much more precision and a watchful eye than cooking savoury food;
• Go through the 3,000 unopened messages saved in in your inbox and commit to deleting at least 2,500 before dinner;
• Colour your hair with a home kit.  It's never as quick as they say on the box.
• Give some attention to your photo program on the computer.  If you aren't going to print them all, surely you could make the program run better if you delete the awful ones, fix some red-eye, correct the lighting, etc..;
• Find a creative outlet for your emotions, in singing, writing, drawing, playing an instrument; and/or
• Go play a sport, with others. It doesn't matter whether its group tennis or swimming laps. Competition involves a high state of focus; the activity is healthy and commitment to a goal inspires hard work.

Even if you shed a few tears, which you probably will, it's okay. Just try not to stay in bed all day with a tissue box at your side, watching sappy, made-for tv movies.  If you need another person to help you through the day:

• take a look, literally or mentally, at your list of people in your support network.  Who can you call upon to keep you company for part of or the whole thing? If you're self-aware, you know who you can lean on, someone who wants the very best for you, and has no stake in the outcome. Many people will be with their own family tomorrow but a text message will probably yield at least someencouraging words.
• If you are attending a Mother's Day celebration for your own mother or mother-in-law, think about asking someone else who will be there to assist you in terminating painful conversations about your infertility.
• Be honest if you cannot bring yourself to attend a Mother's Day get-together. Just give a  brief statement that you're feeling very sensitive and don't think it feels right to be around others celebrating Mother's Day. This will hopefully be just enough to elicit an understanding response. Don't make up excuses; they never sound authentic and could actually hurt someone's feelings. 
• Ask your partner to stay with you all day if necessary. Put yourselves first and nurture the relationship you have; you know, the one that you often take for granted.  Do your mutual nurturing anywhere that isn't crawling with pregnant women or those with pushchairs. If absolutely necessary, go see an R-rated film to gether, so you can be sure there will be no children in the theatre.

Finally, and on a different note, I pose a question for you to answer for yourself. Try to visualise yourself spending this or another Mother's Day with a baby. The holiday is, for you, made all the more special by its comparison with previous Mother's Days. Imagine yourself holding, looking at, cuddling and kissing your baby.  In that picture, the only thing that matters is you and your partner being parents.  Would it feel less joyful if the baby wasn't your biological child?  The baby is yours, but perhaps you had needed egg donation, used a surrogate or adopted him/her. 

Imagine holding the baby, feeling like the luckiest woman in the world at that moment.  Would it matter that (s)he came to you through alternative paths, or would being that child's mother be enough for you? In the days and weeks that follow Mother's Day, look back on those thoughts and ask yourself what matters most to you. If having a biological child is still your number one priority, then by all means, keep pursuing it. If having a child, biological or otherwise, is something you can live with, look at next year's Mother's Day as your first and make that visualisation come true.

Eureka! We Can All Be Tested for Genetic Anomalies, Even Our Embryos

The Times recently published Eureka, a magazine section devoted to science, life and the planet.  I’m more a Home, Travel and Living person, skipping sections on motoring, sport and science, but it’s not every day that we get a separate section coloured section on science (The Times knows that magazine format is eye-catching), so I flicked through. 

My interest is in bringing news of worldwide happenings in the field of fertility medicine, law and practice to public attention, especially the average couple trying to conceive.  The article that attracted my attention was about genetics; about which the average person knows little.  As far as most of us are concerned, genes are what makes you tall like your mother’s side, or have the red hair of your grandfather.  It’s bantered about in lighthearted conversation, such as telling a partner that their child has his “messy” gene or a child’s intelligence “comes from my family.” Genetics is all that and so much more.

You carry a copy of a particular gene from you father and another from your mother.  According to Mark Henderson’s article, all of us probably have one mutant gene we may never know about.   You wouldn’t, as a mere carrier of a disease is not likely to have any symptoms.  Genetic testing has been, therefore, relatively rare.  The chances of conceiving with a partner who has the same mutant gene, is small.  However, it does occur.  Most of us don’t know beforehand about this until it’s too late.  Once they have had one child with the disease that results from the mutant gene, the discovery can prompt medical investigations that will help the parents decide about further pregnancies. In those cases, the NHS may fund embryo screening, but it isn’t available everywhere or to everyone.

What can be done?  There are those people who would choose not to intervene at all, following what they believe is God’s plan and letting nature take its course.  There are others who might test themselves just because they want to be prepared with knowledge of what is to come.  I believe that given the right tools at the right price, most people would choose not to give birth to a child affected by a genetic disease.  For that group, the process would look like this:

· A couple that intends to have children together would pursue genetic testing to determine what they each bring to the table.

· The information collected would, in most cases, confirm the absence of shared mutant genes, after which those couples divert from the testing process and conceive naturally. 

· For those couples who receive negative results from the genetic tests, there may be the need for counseling to help the couple come to terms with the information and how to use it.

· Prepared with knowledge that they each carry the same mutant gene, this couple could 1) choose IVF instead of natural conception and 2) discard any embryo in which  the two copies are found, only implanting healthy embryos. 

· If this couple wanted more children, they could use any remaining healthy embryos that were frozen. Otherwise the woman would have to go through the drug therapy and egg harvesting again.

Fascinating  stuff.  Yes, really.  Eleven years ago, after I had had three miscarriages and was pregnant for the fourth time, I was offered and underwent genetic testing through a “high-risk pregnancy” practice, mostly to pacify me as I had become somewhat paranoid.  It involved filling out a form with such in-depth questions about my family that even my mother and father found it difficult to answer.  We had either been a very fortunate family, or any problems were swept under the rug. My husband filled out a second form of equal breadth.  The blood tests followed and then there was a 3-week wait for results.  Now, though, what was a rare battery of tests is being made available to the public at large.   

The news, only last week, that a company, Counsyl, was bringing a home-screening kit of 109 genetic markers to the UK market is nothing less than revolutionary.  In a country where you have to jump through hoops and be extremely patient to see a specialist on the NHS, many people meekly accept that they will have to ask and wait, and wait, ask and wait for pretty much everything. Because they have national insurance which they pay for out of their taxes, many do not carry private insurance.  I doubt that, even if the NHS could supply enough doctors, nurses and counselors to process the genetic tests, they would give a patient the equivalent of the Counsyl kit at the price of a prescription.  It is destined, in the short to medium term, to be something that prospective parents must be motivated and willing to pay themselves.

The kit could either be administered in a doctor’s office or ordered independently to be used at home.  The medical relevance of this kit’s results is clearly as a first step toward embryo screening.  Most people having it are likely to believe that they have no recessive gene in common with their partner, but want peace of mind.  Those in the clear would not need any further tests, such as the embryo screening. I see it another way as well; the genetic test could be considered preventive medicine, but I doubt that the NHS would agree with me, as its policies are based upon statistics.  However, those who unluckily share the recessive gene, could choose to have IVF and embryo testing, rather than risk the 25% chance their child will be born with that disease. 

I agree with Mark Henderson that demand is likely to grow substantially, once parents realize they can improve their chances of having disease-free children.  One could argue that not undergoing the genetic tests is, therefore, unreasonable and possibly, neglectful.  Would it be fair to give birth to a sick or afflicted child, knowing that they may have a difficult life, a shortened life span and/or be in pain?

The alternative to embryo screening is either choosing not to know what your child may inherit genetically from you or becoming pregnant naturally and having an amniocentesis around week 15 of the pregnancy. Currently with amnio, if a condition such as Down’s syndrome is discovered, parents have an option to undergo a medical abortion.  That is a heartbreaking decision for parents to make, as being in the second trimester, the pregnancy will be showing, people will have been told and a bond will already be made between mother and baby.  Genetic testing would flag a possible problem before getting pregnant.  IVF and embryo screening would prevent the afflicted embryos from being used, virtually eliminating the need for an abortion for medical reasons.

IVF has traditionally been used to help women diagnosed as infertile, to become pregnant.   It is a rigorous process, using mega-doses of medication to induce an artificial menopause and then start from the beginning to induce an over-production of eggs and harvest them.  It’s not fun and games.  Would women who are fertile choose to conceive through means of assisted reproduction techniques like IVF if it meant that they would give birth to healthy children?  Probably;  as IVF has become so widely known in the past decade, it would not be seen as radical, but as the cautious, familiar and reasonable choice.

In thinking about genetic testing and embryo screening, I applaud the advancement of reproductive health medicine for giving more couples the ability to have a child. At the same time, I wonder if scientific progress opens the door to people who would abuse the process by seeking to eliminate embryos for less worthy reasons.  It recalls the Hitler regime’s attempt to create his twisted idea of a perfect Aryan race.  In the UK, health authorities make decisions about whether a couple may be told the gender of their baby, because they fear that certain ethnic groups may choose to abort if the woman is carrying a female fetus.  Taking that into account, it’s unlikely to agree to a woman’s request for IVF and embryo screening.  Currently, there is no line drawn, but the ability to test for a non-life threatening condition, mental impairment  or physical appearance may be challenged before long.

I think it’s quite funny that in the same issue of Eureka, the preceding article was about breeding pedigree dogs in pursuit of genetic perfection.  It seems to have been mostly due to inbreeding within the pedigree.  This can cause pain and ill health to the dogs, including a 100% greater chance to have cancer.  The experts quoted in the article seemed to think this could be improved by a “systematic program of outbreeding.” So, genetics are the hot topic this week for both man and his best friend.  It remains to be seen what the medical and veterinary medicine practitioners will do next and whether it will be a program that the UK government gets behind.