#hospitalbreastfeeding New Horizons

I had a really positive meeting last week with Liz Edwards, Head of Patient Experience at Alder Hey Children’s Hospital.  Up until that point I had been working with Liz Grady (everyone at AH is called Liz apparently) who had been responsible for breastfeeding support in the hospital.  Liz Grady has generously involved me in the drafting of the hospital’s new breastfeeding policies, and in the drafting of a breastfeeding information booklet for families.  It is a testament to how much the hospital values patient feedback that I have been able to really work on all of this with Alder Hey, rather than being brushed aside after my initial complaint.

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The atrium in the fabulous new hospital

Liz Grady is now working on new challenges within the hospital, and to whom will fall the responsibility for breastfeeding support is still under discussion.  The whole hospital has very recently moved into a magnificent new building, and you can imagine the chaos of transition.  But Liz Edwards is not interested in that being an excuse for inaction for much longer.  I was delighted to find that she and I agree on many things when it comes to breastfeeding and sick babies.  That could of course have something to do with her background in midwifery.

We discussed the curriculum at the university where the majority of Alder Hey’s nurses are trained.  We discussed UNICEF Baby Friendly Initiative’s new breastfeeding training course for paediatric nurses.  We talked about peer support and the different ways that other hospitals support their families.  I also mentioned that I had highlighted to the Improving ME maternity review that postnatal experiences are taking place at Alder Hey – it should very much be under the remit of any review of maternity care on Merseyside.

Most excitingly, Liz confirmed that the new breastfeeding booklets for families have been finalised.  Breastfeeding mothers at Alder Hey should now start to receive these as a matter of course, and they contain a wealth of information.  They include:

  • Positioning and attachment
  • Feeding cues and signs of a successful feed
  • Hand expressing and storage of breast milk
  • Use of breast pumps
  • Non-nutritive sucking and skin-to-skin
  • Care of the breastfeeding mum
  • Sources of support, including the National Breastfeeding Helpline

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I know that Wendy Jones of the Drugs in Breastmilk Helpline will be particularly pleased to see this information clearly displayed:

AH bf booklet medications

Change is happening slowly.  Improvements have been made and will continue to be made.  I have every hope that 2016 will be the year when Alder Hey’s breastfeeding support catches up with its excellence in clinical care.  Because for many children, breastmilk is a part of that care.

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Midwives & Health Visitors – let’s connect!

As I mentioned in my round up of #OxyOct for the #MatExp campaign, Sheena Byrom very kindly invited me to host a #WeMidwives Twitter chat on the subject of collaboration between midwives and health visitors.  A new pathway for Health Visiting and Midwifery partnership was recently launched by Public Health England, and with the CPHVA conference underway in Manchester last week it seemed an ideal time to discuss this.  The topic has already been covered here for #MatExp and the campaign includes many dedicated and passionate professionals from both midwifery and health visiting.  So on Thursday evening of last week we kicked off “Midwives and Health Visitors – let’s connect!”

WeMidwives

Before opening the questions, I posted a link to this blog by health visitor Jenny Harmer, as it is an excellent explanation of the role of the health visitor and what they actually do.  Misunderstandings or lack of knowledge about the role of the HV are a key barrier to parents approaching them for support, and to other professions signposting to them.

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My first question was:

Midwives and Health Visitors, how do you work together in your communities and ensure smooth handovers for families?

There were certainly areas of best practice:

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WM Lynn Christie

WM Lynn Christie 2

WM Joint visits

And pretty quickly the idea of joint training arose:

WM joint training

It seems to be the case that teams who started on Baby Friendly pathways some time ago already train their midwives and health visitors together, as this used to be sensible for the original BFI standards.  Although BFI no longer works that way, the teams are still collaborating in these areas.

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Where the individual teams are based was also discussed:

WM building separate

WM building barriers

This was a theme that emerged at a #MatExp meet up a few of us had in Manchester earlier in the week.  Teams that are co-located will naturally find it easier to build relationships and collaborate.  However, separate building need not necessarily be a barrier to teamwork.

WM co location not necessary

Children’s Centres were identified as one of the obvious places where midwives and health visitors can physically work together, although I did point out that in many areas (including my own) Children’s Centres are being closed down at an alarming rate.

WM building connect

 

Question 2:

How are antenatal visits from health visitors impacting on collaboration? Do these happen in your area?

The health visitors I have spoken to are overwhelmingly in favour of the new antenatal visits, as they provide an opportunity for the HV to build a relationship with a family before the baby arrives.  A baseline for mental health can be obtained and important issues discussed before the parents enter the fog of the newborn weeks.  As the families are under the care of their midwives at this point, surely it makes sense for some of these visits and contacts to be undertaken together?

WM joint booking

WM Joint visits

WM joint visits 2

Issues of time available, size of caseload and the individual needs and wishes of families were brought up.  There is no “one size fits all” solution here – for some families a joint antenatal visit would be inappropriate – but having the option available would be a positive. And having teams working closely enough together to make it a possibility would benefit all families.

 

Question 3:

What are your thoughts on the new pathway, is it achievable?

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WM Angela

Whilst the pathway provides a standard to work towards, it might be that the individual relationships and local networks are not yet at a point where it is realistic for all.  Always with the #MatExp focus on individual ACTION in my mind, my fourth question was:

What can individual professionals do to improve their working relationships between midwifery and health visiting teams?

WM Lynn what can be done

Again we came back to the lack of understanding amongst parents of the role of the health visitor, and how midwives can help to ensure that families don’t miss out on vital HV support.

WM HV service introduced early

The discussion ran on into the following day as individuals continued to explore themes raised during the hour.  It became very clear that, whilst services are overstretched and morale can be low due to pressures within, there are professionals who are passionate about collaborative working.  Those people can encourage their colleagues to reach out to other professions, and to put families at the centre.  Spread the word!

WM world as it should be

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WM no them and us

WM closing thoughts

Join the conversations taking place on Facebook and Twitter, and in your own homes, wards and offices.  Join like-minded professionals who are keen to push things forward for the families they support.  All aboard the #MatExp train!

WM MatExp train

#MatExpOnTour in Manchester

The #MatExpOnTour bus hit Manchester yesterday when eight members of the campaign met up for a cuppa and a chat about maternity services.

Tour Bus

There was a community midwife, two health visitors, an antenatal teacher, a doula and three mothers all of whom are involved in various maternity projects.  We had connected on Facebook and Twitter and decided to set up a meeting, particularly because a few health visitors are in town for the CPHVA conference.

Since #MatExpOnTour launched for November a few people have asked me when the tour bus is coming to their area.  This misunderstands how the campaign works.  You are touring with #MatExp whenever you meet up to discuss maternity services.  If you want the bus to come to your home town then get some people together and discuss ways in which maternity services can improve.  Done that?  Then you’ve joined the tour!

We had 2 hours together yesterday and we discussed so many of the recurring #MatExp themes:

  • Perinatal mental health
  • Evidence based practice
  • Approaches to birth
  • Working conditions
  • The need for compassion
  • Leadership and change management
  • Hearing the voice of service users
  • Informed choice

We learned of new projects in the area and of projects campaign members are keen to set up.  We shared our frustrations and our experiences.  We made new connections, and I know some of those were continued over a glass of wine or two that very evening!

One of the focus topics for #MatExp this week is collaboration between midwives and health visitors.  We talked about what can be done here and what best practice people had come across.

It was agreed that the following can make a difference to how well the teams work together:

  • Attendance at each other’s monthly team meetings
  • Being open and amenable to contact and queries from different teams
  • Making it your business to get to know members of other teams
  • Taking opportunities to work together
  • If as a health visitor you are working on early intervention, think about how you can involve your local midwives
  • Consider involving the midwife in your antenatal HV visit

The group was surprised to hear that the information collected by midwives at booking appointment is not passed on to the health visiting teams – all that is passed on is very basic information rather than the detail that the maternity notes will hold.  This is something that could change to ensure smooth handovers and a more holistic approach for families.  Location was also mentioned – teams that work well together are often located in the same building, sometimes along with a GP practice.

We talked about the different service levels that health visitors can offer and what those can mean to families in practice.  A clear infographic of this information would be of huge benefit to families, midwives and antenatal teachers.

One particular lightbulb moment was when we discussed whether health visitors ever seek to work together with doulas?  The HVs and doula in the room were swapping information and I have a few contacts that I am going to pass on as a result of that conversation.  Imagine how much families will benefit if their midwives, doulas, antenatal teachers and health visitors know each other and share information.

Connections.  Collaborations.  Networks.  Shared ideas.

#MatExpOnTour

Manchester

#hospitalbreastfeeding discussion on #MatExpHour

NICU nurse Louise is now hosting a weekly Twitter chat for the #MatExp campaign called #MatExpHour. It takes place every Friday, alternating between a midday-1pm and a 8pm-9pm timeslot.  Yesterday I had the privilege of co-hosting with Louise as the topic was breastfeeding support on paediatric wards – the focus of my #hospitalbreastfeeding campaign.

In previous discussions on this topic I have looked at the needs of cardiac babies, the knowledge of healthcare professionals when it comes to specific breastfeeding problems, and the role of International Board Certified Lactation Consultants (IBCLCs) in supporting breastfeeding in difficult circumstances.  For last night’s chat I wanted to go a bit more “back to basics”.  So I asked the following four questions:

  1. Is everyone aware of the new Baby Friendly training for paediatric nurses? Who has signed up?
  2. Are all children’s wards equipped to keep breastfeeding mums and children together?
  3. Do all children’s wards provide food and drink to breastfeeding mums?
  4. Can breastfeeding peer support work on children’s wards? What are the barriers?

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The new BFI training looks fab (if pricey at £450):

BFI training capture

We discussed the fact that finding funding for individuals to complete the two day course might be difficult.

ESas BFI

Michelle BFI

But there was no doubt that it is much needed.  Even in Baby Friendly accredited hospitals the paediatric nurses (and doctors) are often under-informed with regards to infant feeding. The fact that Baby Friendly are now offering this course is a step in the right direction, as paediatrics have been left out of the BFI system for too long.  It came as a surprise to some that there is currently no BFI pathway for children’s wards or children’s hospitals.  I suggested that the BFI team might well be a bit sick of hearing me bang on about that gap!

Carmel BFI

So when a breastfed child is admitted to paediatrics, are the basics covered?  Are mum and child kept together, and is mum provided with food and drink free of charge?

Firstly I should explain the rationale behind the food and drink issue.  In an ideal world all parents of sick children would be provided with food and drink so that they can stay by their children without having to worry about finding meals or paying for them.  However, that is not a realistic possibility in our healthcare system.  However, a breastfeeding mother is producing food for her child, the patient.  Her ability to produce that milk relies on her being well fed and hydrated.  As a result, providing her with food is a part of providing nutrition to the patient, which is absolutely a part of a hospital’s remit.

The World Health Organisation’s Global Strategy for Infant and Young Child Feeding makes it clear that “Mothers and babies form an inseparable biological and social unit; the health and nutrition of one group cannot be divorced from the health and nutrition of the other.” (page 10)

So what are the practices around the country?

Louise

Louise 2

Louise 3

Lorraine

Emma

And the provision of food and drink?

Food - Louise

Food - Louise 2

Food - Louise P

Food - me

This was interesting, as discussions earlier in the week on the #MatExp Facebook group had suggested that the provision of food and drink to breastfeeding mothers is not universal practice.  One member commented that “At our local hospital they are obligated to treat a breastfeeding Mum as another patient, including food.”  Yet others reported that this is not the policy in their hospitals, and one doula mentioned that a particular hospital used to provide food and drink to breastfeeding mothers but no longer does so.  A worrying step backwards.

One mum reported:

Well for 3 days I was living off microwave meals my husband brought in while I was staying in NICU.  As a vegetarian the options are limited for microwave meals. I was so exhausted I barely had the energy to make toast or use the microwave. I had been told you had to be self catering in the NICU parents’ accommodation. Turned out that was b******s and eventually a NICU nurse explained that if I went down to the postnatal ward at set times I could collect meals. Which I then did for 7 days when I could.  Although due to the rigid feeding/expressing schedule I wasn’t always able to leave NICU at the right time to fetch my dinner. It seemed so unfair that the ladies in postnatal who had their babies with them got food brought to them, but us NICU mums had to leave our sick babies, go down a floor and get buzzed in to the postnatal ward to practically beg for food.
I was not the only mum who wasn’t told she could get fed.

Any breastfeeding mother will tell you just how much food and drink you need, especially in the early days, to maintain your supply and provide for your baby. That this is overlooked in some hospitals is a big concern.

Emma selfie

BfN trained NHS breastfeeding support worker Emma Sasaru

Understanding as we do that doctors and nurses have limited time available to them, even if they were all to be trained in breastfeeding support is there still a place for peer support on paediatric wards?  NHS breastfeeding support worker Emma (pictured above) has written about the in hospital service she works for and how they support breastfeeding families.  The team covers paediatrics as well as NICU, postnatal and community.  A model for other trusts to consider?

Val

I know of instances where breastfeeding peer supporters have clashed with clinical teams so expressed a concern that if peer support is to work it needs to have buy in from the doctors, and respect needs to be shown for the expertise of both sides.  Perhaps in an ideal world, when BFI training is made available for paediatricians, the nurses, doctors and peer supporters from a hospital will all train together?

Tim

I would like to once again thank everyone who took part in the discussion, and to ask anyone with an interest in breastfeeding support on children’s wards to take a look at my website and to follow the #hospitalbreastfeeding hashtag on Twitter.  There is also now a page for you to follow on Facebook: https://www.facebook.com/hospitalbreastfeeding/ Hope these platforms can bring together all those who are interested in helping sick children to breastfeed.

#hospitalbreastfeeding flyer

#hospitalbreastfeeding flyer

Tall Poppies

I will be going to the cenotaph in my town this morning to stand with hundreds of others for the silence at 11:00am.  I try to go every year, but wherever I am I always observe the silence.  And I always wear a poppy.

tall poppy 2

This year my four year old has been asking about why I have a paper poppy on my coat, and I have tried to explain it to him simply.  We remember all of the soldiers who died or were hurt in a very big war a hundred years ago, and all the soldiers who have died or been hurt in wars ever since.  We also try to remember to be kind to each other and not to let our disagreements end in fighting.  We try to think about ways to solve our disagreements with discussion.

The word “courage” is used a lot at this time of the year.  I have no doubt that enormous courage was displayed in the Great War and continues to be displayed by service men and women today.  Yet I imagine that for many of the participants it was like any other time when you are thrust into a frightening experience – you get on with it as best you can, one foot in front of the other.  You probably don’t acquit yourself admirably all of the time.  You just keep going.  And hope you come out into the light again.

We also talk about courage a lot in #MatExp. Midwife Jenny Clarke writes about “courage butter” and how it must be spread around the healthcare profession to ensure compassionate and safe care.  And when we talk about professionals speaking out against unsafe practices, non-evidence based care and non-women centred approaches we call them “tall poppies”.

If you look it up on Wikipedia, the phrase “tall poppies” refers to “a social phenomenon in which people of genuine merit are resented, attacked, cut down, or criticised because their talents or achievements elevate them above or distinguish them from their peers”.  Their courage is feared and resented.  They are criticised for deviating from the norm, bucking the system, questioning the accepted wisdom and encouraging a new approach.  They work in institutions that do not encourage original thinking.

In World War One pacifists who refused military service were imprisoned for their beliefs.  Pacifists were reviled in society as cowards and deserters.  They refused to follow without question.  They stood up for their beliefs and spoke out against what they saw as wrong.  They were different.  And that is not something that society ever accepts with ease.

There are many different types of courage.  There is being a tall poppy, standing up for what you believe in, being true to yourself despite near universal opposition and trying to be the change you want to see in the world.

There is following the crowd because you feel it is your duty to do so, despite your overwhelming fear. There is standing together with your team, your comrades, your tribe, holding the line and fighting on together, even when at times your cause seems impossible.

There is pushing yourself to simply keep going, every single day, even though you can taste the fear in your mouth and you feel as though you can no longer face what you are expected to face.  There is putting one foot in front of the other.  Every day.

And there is the courage that only others can see.  When they tell you that you are courageous. And inspirational. But you don’t believe it because you know how scared you are, and how you don’t always do the right thing, and how you struggle every day to do the things that you do.  You don’t feel courageous.  You feel scared and alone.

Today I will be remembering the millions of men and women who stood together and died together in active service.  I will be remembering those who refused to join that crowd.  I will be remembering those who believed in the cause, those who reviled the cause and the many many who went along in ignorance, fought in desperation and died in fear.

And I will also be thinking about my own team, my own tribe, even though we are fortunate enough never to have to face the guns of war.  I know many tall poppies who are speaking out for the good of families and for the good of their own colleagues, despite those in authority trying to silence them, or distort their intentions or push them out of their profession.  I know many dedicated professionals who stand with their team every day, every shift, and work for progress even though it often only comes by inches.  And I know many who simply turn up every day, embattled and exhausted, putting one foot in front of the other using all of their courage to keep on keeping on.

There are many kinds of courage.  We all have it within us.  And it should be celebrated when we see it.  Because it is courage that holds the line, that keeps us together, that shows us the way to resolve conflict and to make progress, inch by inch.  When I think of the men and women who died in World War One I don’t think of them as extraordinary.  I think of them as ordinary, everyday people – you and me, our family and friends.  Because that is what they were.  They faced their times in their own way and so many of them were courageous.  Even when they didn’t feel it.  Even when society didn’t recognise it.  Even when no one was left to remember it.

We will remember them.  We will be them.  We will honour them.  And we will be courageous in their memory.

It’s Complicated

The latest initiative for the #MatExp campaign is #MatExpOnTour, collating news of all meet ups, tweet ups, events and conferences where maternity experience is being discussed.  The tour bus made a stop in Manchester today for my #MatExp colleagues and I, but it was a more subdued event than the campaign is used to.  Emma, Susanne and I had the privilege of being involved in a National Maternity Review listening event specifically for parents who experienced complications in pregnancy, labour or birth affecting the health of mother or baby, including admission to neonatal care.  The session was facilitated by Bliss.

I had faffed around all week about this event.  First I was going, then I wasn’t, then I could, then I couldn’t, then I needed childcare and then I didn’t.  The truth is I was never fully confident that I belonged there.  In the end I did what I often do – I sourced feedback on the topic from a number of friends and contacts and took that along with me so that if I felt that my experience was invalid, well at least I had other people’s to discuss.

Invalid?  David was on NICU wasn’t he?  I experienced a complication in pregnancy didn’t I?  One minute we were planning a second homebirth, the next we were being prepped for a caesarean due to David’s congenital heart defect.  That certainly sounds like a complication!

But here’s the thing about complicated pregnancies, traumatic labours, postnatal struggles and spells on NICU: they are emotionally exhausting.  You are wrung out and trampled on and put through it and spun around and hung out to dry and worst of all at the time you don’t feel like it’s too bad.  Or you do but you’re numb to it.  Or you do but you can’t quite believe that it’s happening.  And by the time, months or years later that you are able to make any sense of it all you can no longer trust your memory.  All you have is a set of confused emotions and images, and you’re not really sure whether your experience was truly awful or whether you are just dramatising for effect.  And you are wary of people’s perceptions.

Which is why all three of us were anxious about attending today’s event.  Yet we needn’t have worried.  Yes it was very emotional – tears were shed.  But it was expertly facilitated by Bliss.  The questions they asked, the way that they listened, the comments they made, the compassion they showed, completely hit the spot and enabled us all to share what some of us had never shared before.  And enabled us to support each other and get across what we most wanted the maternity review panel to know.

It was agreed that the discussions would be kept confidential, but I think I can share with you some of the remarks that review panel Chair Julie Cumberlege made at the start and end of the session.  She opened by asking whether we should still be thinking in terms of “high” and “low” risk women, or whether we should be looking at families holistically and wrapping services around them.  She highlighted four areas that the review panel are seeing as important:

  • Kindness
  • Safety
  • The involvement of Fathers and Partners
  • That services be Professional

Baroness Cumberlege also made it clear that the review panel’s report is only the start.  They are “very determined” that the report will be implemented, but this will be a huge challenge.

At the end of our discussion, when we had shared the guilt, the anxiety, the depression, the fear, the anger and the confusion, we were asked to talk about the key things that would have made a difference to our experiences.  Some ideas that came up were:

  • Peer support in NICUs and on children’s wards
  • Better provision of information during pregnancy
  • Better communication between maternity wards and NICU
  • Time taken to explain what is happening to families
  • Kindness

Breastfeeding support was touched upon and I of course mentioned www.heartmummy.co.uk and the #hospitalbreastfeeding campaign. I also highlighted the worth of the Small Wonders DVD from Best Beginnings and expressed the hope that it will start to be given out on all units caring for premature or sick babies.  And that it be given out at the start of the stay, not when families are bringing baby home!

Julie Cumberlege said as she left that it had been “a real eye opener” to see “the implications for parents”.  I had been sharing the title of the session on social media all week: “for parents who experienced complications in pregnancy, labour or birth affecting the health of mother or baby, including admission to neonatal care.”  Today we looked at what those words actually mean.  Complications in pregnancy: fear, uncertainty, Googling strange terms, lying awake at night worrying about your unborn child, having birth choices taken away from you.  Complications in labour or birth: terror, loss of control, confusion, pain, loss of consciousness, bewilderment.  Affecting the health of mother: pain, fear, guilt at not being able to fully care for her baby, long term mental health issues even when physical wounds are healed.  Affecting the health of baby: confusion over medical terms, uncertainty over what you are allowed to do with your own child, gut wrenching fear and anxiety, feeling that your baby belongs to the hospital, and guilt.  So much guilt.

I hope that the review team is able to influence the way that families are supported in these circumstances.  I hope that it is remembered that many babies are transferred to children’s wards so postnatal services need to stretch that far.  But most of all I hope that maternity services of all stripes are restructured in a way that encourages kindness.  Give us your time.  Give us your attention.  Give us some information and give us your understanding.  Because we’ve had a fair amount taken away.

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If you have experienced complications in pregnancy, labour or birth affecting the health of mother or baby, including admission to neonatal care, please complete this anonymous survey for the National Maternity Review.  Open until 30 November 2015.

Family, Friends, Food and Fresh Air

We are in the week between Halloween and Bonfire Night, or in what I have started to refer to as the week of the Autumn Festival.  As humans we feel the need to mark the changing seasons, and it makes sense that we do so.  Most of our seasonal festivals have a Christian element, including Halloween which traditionally was “All Hallows Eve” or the day before All Saints Day.  It sometimes feels as though if you are not religious these events are reduced to commercialism and a way to fill the children with sugar.  Yet I believe there are important things for humans to consider and celebrate throughout the year.

There is plenty of information out there about how Christianity co-opted existing festivals and how certain times of the year are celebrated in similar ways by many religions.  It is not surprising – as midwife Mark Harris points out we are “meaning making creatures” and we like to make sense of the world around us and our experience of it.  The seasons and the weather are totally beyond our control.  This was terrifying in the days when we had little shelter or ability to cope with extremes.  It is still terrifying today as we are so used to being able to control so much about our lives, that we are up in arms if faced with a flood, drought, hurricane or power cut.  Why wasn’t something done?  Why are these things allowed to happen?

Autumn

Celebrating and marking Autumn, Midwinter, Spring and Summer allow us to face our fears and celebrate the ways in which we overcome them.  Halloween may have a Christian element, Bonfire Night may be a historical tradition, but there is a reason they have both survived despite huge changes in the way they are marked.  As the nights draw in and winter approaches it is helpful to face our fears of the dark.  To make light and make lots of noise to frighten away the spectres.  Much of Halloween is a confrontation of our darker selves and that within us which frightens us.  So many people who suffer from anxiety and depression struggle more with the cold, dark seasons.  So we brighten up the night sky, we treat ourselves to sugary snacks and we laugh at that which scares us.  We will not be cowed by winter.

Midwinter arrives and it is natural that we should celebrate on a massive scale.  If we are fortunate, we have survived another year as have our family and friends.  If we are lucky we have warmth, food and plenty even in the depths of the coldest season.  We have love, we have our family and friends around us.  And we think about those who are not so fortunate and who need our support, our time, our gifts and our donations.

Winter

We celebrate Christmas with feasting and treats.  We stick up two fingers to the winter and the fact that in years gone by we would have found it difficult to preserve food or find it at this time of the year.  We are so lucky to have plenty to eat, and we are so relieved to have it when many others do not.  And we share this plenty with our loved ones.  Our tribe.  Safe and warm together.

Again, we use light to chase away the dark.  So many Christmas decorations and traditions involve light and warmth.  Again, we make noise but this time by means of song.  Carols, Christmas music, parties and dancing – we light up the dark, we frighten away the winter nasties with our festive cheer and we keep each other warm, physically and emotionally.

It is no coincidence that the personification of this winter festival, Father Christmas, is a fat jolly man in warm clothes.  He clearly has plenty to eat, he is full of cheer on the darkest days of the year, he is warm and welcoming and embraces all children.  He underlines our plenty and good fortune by showering us with gifts.

It is these themes that make Christmas such a particularly difficult time for those without loved ones, for those who have lost close friends and family members and for those who do not experience good fortune.  And it is part of our shared humanity that we help and include those people in our celebrations where we can.

Spring

And then, spring time!  The nights draw out, the sun comes up, new plants push through the soil and baby animals are born.  We celebrate with chick, lamb and rabbit motifs, with eggs and daffodils, and with Mothering Sunday to salute the women who bring forth and nurture new life in our species.  Once again, we do that very human thing – we feast.  We gorge on chocolate, roast lamb and sweet breads.  And we include our family and friends in the celebrations.

Summer no longer has a particular national point of celebration, although May Day and midsummer are still marked by some.  But you only have to look at the travel agents and the summer holiday suggestion pages to see how we elevate the summer break.  Did you have a good summer?  How was your summer?  What have you got planned for the summer?  The summer break is not just a time for children to rest from school – it is a time for travel and adventure, sight seeing and family gatherings.  No matter how we actually spend the summer months we all have the idealised vision of paddling in streams, running on the beach, walking in the park and lazing in the sunshine.  We are never happier than when we can break out the sandpits, paddling pools and barbecues.  Let the fun begin!

Summer

In all of these celebrations there is another crucial element: fresh air.  Fresh air is so important for our mental health and wellbeing.  We go outside on Halloween to trudge through the cold evening air in search of candy.  We gather outside on Bonfire Night to watch the show.  We feel that Christmas is somehow incomplete without a snowball fight and the ability to toboggan in the park.  Easter is indelibly linked to the outdoors, and of course being outside in the warm sunshine is what summer is all about.

No matter what commercial interests try to sell to us, we instinctively know what we need to keep us going.  We need our family around us.  We need our friends.  We need good food.  And we need fresh air.  These are the things upon which we focus at the four corners of the year, and it is what keeps us going through the cold, through the down times, through the soggy summer days and through the times away from our loved ones.  By all means spend a fortune in the shops if you really want to.  But if you worry about commercialism, secularism or a lack of tradition just remember this: it’s all about family, friends, food and fresh air.

Happy Autumn!