Stop the conflicting advice over childbirth – leave the black-and-white thinking to pandas

Like dying, birth is something we can all relate to.

There are many things you notice when you’re pregnant: the panicked look people give you when they’re not sure if you’re carrying a child or pronounced excess fat around your belly; the pointed glances from mothers with wailing toddlers that seem to say, “Just you wait!”; the almost competitive kindness of strangers to accommodate your new girth on the Tube (I’ve had whole rows urgently offering me their seats). Sometimes the attention is welcome – I’ll take the seat – but sometimes it’s excessive and wearying (the automatic download of unasked-for advice from veteran parents).

And then there’s the news. Stories directly relevant to my biological state cover the pages. In the past couple of weeks alone there was the furore around household chemicals that pregnant women were supposed to avoid: moisturisers, sun creams, food packaging, non-stick pans, shower gels, make-up. The authors evidently lived in a Henry David Thoreau-like wilderness, subsisting on a diet of home-grown turnips and forsaking all personal hygiene, such was the realism of their warnings.

Then there was the Drinking During Pregnancy Debate part 23, this time suggesting that the odd glass of wine was probably fine. To summarise all preceding 22 parts of the debate: it’s OK to drink, it’s not OK to drink; your child will probably be fine if you drink, you’re going to harm your unborn baby if you drink; your child will be a creative genius if you drink, your child will most likely initiate a school shooting if you drink – and so on. Most recently there was an anguished bellow about breastfeeding: apparently the number of children being breastfed has fallen for the first time in a decade.

On it goes: endless theorising, judging, arguing and counter-arguing about the best way people can do the thing they’ve been quietly getting on with for thousands of years. I don’t know if it’s worse now than it ever was: I’ve never been pregnant before. But quite quickly, as this small human grows inside you, you develop an awareness of the pious circus around reproduction, the apparently limitless opportunity for humourless hectoring, the persistent blast of moralising opinion.

At least I’m not Kate. Or Kim. Both the Duchess of Cambridge and the reality television star and mother of Kanye West’s child (I spent a long time trying to think of another, more succinct way of describing Kim Kardashian but there’s no way round it) have come under the kind of scrutiny during their pregnancies that might send any mortal mad. But then these women, by their own choice, exist for public performance. That is what they do. Even so, you can’t believe Kate enjoyed the bank of cameras outside the hospital where she was treated for copious puking; nor does it seem possible that Kardashian, the first lady of self-publicity, relished her ultrasound pictures being leaked to the press. Though she was happy to find out the sex of her baby on her television show, suggesting that her privacy barriers are somewhat porous.

Like dying, birth is something we can all relate to. Perhaps that’s why the appetite for such stories will never dim. Everyone can apply it to themselves even if they have no desire for children of their own: they were once born, they had mothers, they played their unrequested part in the life cycle. The closer I get to the big drop, as the father of a friend put it, the less I want to read and hear and talk about it. Or at least, the less I want to read and hear and talk about all the layers of stuff around it: the various methods and theories and speculations, which all seem to contradict each other, escalating into that high and agonising hum that calls itself, hilariously, a parenting philosophy.

I’m now firmly of the belief that childrearing should be approached in the manner I’ve found most reliable in other parts of life: chaotically muddling through.

Saying that, there has been one parenting story that has caught my eye in recent weeks, a story that I obsessively tracked around the internet for an evening. It’s the story of Haizi, a female giant panda in the Sichuan province of China who on 22 June, at around 5pm, gave birth to twin cubs. They came out ten minutes apart, both apparently healthy, and are the first giant panda cubs to be born in the world this year. Their conception alone is a sort of miracle – not quite immaculate but not far off.

Giant pandas are endangered (there are as few as 1,600 in the wild) and in captivity, they unhelpfully tend to lose their mojo, shall we say, and go off the idea of mating. Not only that, the females’ period of fertility is brief – only two or three days a year. Haizi hit the sweet spot in March when she mated with two males, Bai Yang and Yi Bao, and began to exhibit, the Xinhua state news agency delicately declared, prenatal behaviour in May. There’s some footage, and it’s an amazing thing to see: a hulking bear with her miniature offspring, skinny and pink. Panda cubs turn grey after a few weeks and only eventually black and white, and they start life a nine-hundredth of the size of their mother, one of the smallest ratios between child and parent among mammals. (I think of this fact, enviously, quite often.)

There was a particular line in the Xinhua story that stayed with me. The mother, wrote the reporter, has yet to release the first cub from her embrace. The conservationists think the cub is healthy from its size and the noises it is making, but they haven’t got their hands on it yet. Haizi is clinging on. I’m loathe to anthropomorphise, but I like the idea that Haizi is, perhaps, just for a few days, trying to protect her cub from the glare of the world; trying, also, to maintain a quietness around something intimate and private (the anti-Kim approach). She has done something simple, but also special, and ultimately it doesn’t concern anyone else at all.

One of the Giant Panda twins borned to a panda named Haizi in China. Photograph: Getty Images

Sophie Elmhirst is features editor of the New Statesman

This article first appeared in the 01 July 2013 issue of the New Statesman, Brazil erupts

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide