Valerie Gommon Midwife’s Blog

Archive for the ‘3 Shires Midwife’ Category

Guest blog from Hazel Roberts, Jammy Cow MK www.jammycowmk.co.uk

Valerie says, “I am delighted to have been part of Milton Keynes Midnight Moo, and part of the Moos at Ten team!”

Hazel writes:

Last Saturday night  was the 2012 Midnight Moo – an all ladies 10 mile walk through Milton Keynes. The herd set off a midnight and whilst they were busy striding through the early miles, Jammy Cow and her heifer friends were busy preparing the final mile for their welcome home.
At the beginning of mile 10, ready to greet the herd for their final mile was the very professional Moos at Ten Cow, Mavis.  She is a very sensible and reliable cow and in stark contrast to the next cow round the first corner. Silly Cow, Connie giggled her way through the night.
Those of you who walked the 10 miles will know that most of mile 10 is uphill so the Moos at Ten team were ready to add that extra bit of encouragement as the herd came through. Having said that, Bossy Cow’s version of encouragement is about as friendly as bootcamp with her strident, “Keep moooving!” shout. It is at this point in the early hours of the morning that you realise exactly how far 10 miles is to walk. “Holy cow, aren’t we there yet?” you may mutter as you pass the pious Holy Cow, Mary.

Continuing up Midsummer Boulevard, the end is near and breakfast at Pret A Manger awaits, a thought not lost on the perpetually hungry Fat Cow, Victoria as she patiently waved the crowds through. Normally, Hetty the Mad Cow stands out as a bit odd but last night she was in good company with lots of ladies suitably dressed up for the night.

Through Witan Gate underpass and by now there is less than half a mile to go. Bed is calling and lucky you, you’ll soon be home and tucked up. Lucy, the Lucky Cow was there, cheering you on for the final push. And only another 50 calories left to burn, something Clover, the Skinny Cow was quick to point out. Nearly at the end of mile 10 now and so very close to achieving your aim. A point to feel proud and to reflect upon why you are doing this. Willen Hospice is a fantastic cause and everyone is impressed by your fundraising efforts. Remember those Concrete Cows you passed in mile 7, well one makes a final appearance here to salute your efforts on behalf of Milton Keynes.

And there, with the end in sight, Jammy Cow welcomes you to the end of mile 10 and congratulates you on completing the Midnight Moo. A big cheer, breakfast, bath and bed.

So can you work out how many cows there were on mile 10 of the Midnight Moo? If you can and you are local to Milton Keynes then why not enter our competition to win a fabulous hamper of goodies. Visit www.themoosatten.co.uk or email your answer to enquiries@jammycowmk.co.uk

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Optimal Fetal Positioning (OFP) – Encouraging your baby into the best position for birth.  How and why? (including quotes from local independent midwife Valerie Gommon)

The best position for birth is when the baby’s head is down and facing the mothers back and baby’s spine is to the left of your navel (known as left anterior/lateral position).  In this position the baby can pass most easily through the mothers pelvis.  This will ensure a quicker and easier delivery.

Towards the end of pregnancy it is advisable not to slump back on the sofa as gravity will encourage your baby’s  spine (the heaviest part of her body) to swing back towards yours!  Instead, remember the good posture you have worked so hard to develop during your pregnancy yoga classes!  This will gently tilt your pelvis forwards, as well as maximise the space your baby has to move around in.  Whenever possible lean forwards to rest e.g over a yoga ball, table or legs wide over a backwards facing chair.  As in our yoga classes, remember to use cushions to allow your hips to be level or higher than your knees when sitting.  Use cat pose when ever you have a moment.  Valerie also suggests: “getting  onto your hands and knees to wash the kitchen floor or play with your toddler!” or just enjoy moving with your breath!
Another suggestion is that you “lie on your left side on the sofa with your belly hanging slightly over the edge – a nice relaxing way of encouraging your baby into the best position!” (Valerie Gommon).
However, do keep things in perspective if hoping to turn your baby…be comfortable, stay active and above all enjoy your pregnancy.
Remember babies can decide to turn right up to the last minute and some babies are just happy where they are whatever plans you might have for them!!
Sarah Cooper.

Very sadly it looks fairly certain that Independent Midwifery will end in October 2013.  The Government and Nursing and Midwifery Council have for a long time been recommending that Independent Midwives should have professional indemnity insurance (negligence insurance) despite it not being commercially available in the marketplace i.e. insurers do not provide this insurance for midwives.  You can read more about the current situation here http://www.independentmidwives.org.uk/?node=11615

An E.U. Directive is now due to come into force to implement this change and our current information is that it will be illegal for us to practice without professional indemnity insurance from October 2013.  This means that women will be denied the choice of choosing an Independent Midwife and we will be denied the choice of working independently and will be forced to stop practising or to return into the NHS.

The Independent Midwives UK organisation has been working tirelessly for years to find a solution and it is just possible that an eleventh hour solution will be found but this is now looking unlikely.

A group of midwives have formed an organisation called Neighbourhood Midwives www.neighbourhoodmidwives.org.uk/ and are working towards setting up an employee-owned social enterprise organization, to provide an NHS commissioned caseload midwifery homebirth service, based in the local community.  This may prove to be a workable alternative to Independent Midwifery but at present (if it comes to fruition) the service will only be able to accept “low-risk” women and this is of concern to all of us who have supported women with more complex situations, for example first time mothers, vaginal birth after a previous caesarean, twins, breech birth and women who are not deemed “low risk”.  The aim of Neighbourhood Midwives will be to extend their remit to include more women as soon as possible.

There is already a precedent for this type of care as One to One Midwives in Liverpool www.onetoonemidwives.org have already managed to set up a caseloading midwifery service (similar to independent midwifery in that a woman will care for a caseload of women throughout the whole of the pregnancy, birth and postnatal period) within the NHS.

It is a very sad time for midwifery and for women’s choice, but perhaps good things will come out of it, I certainly hope so.

Where to start?  Every day is different, so I’m going to give you a flavour of the sort of things I get up to.

Of course I have antenatal appointments; from the first tentative telephone enquiry I then arrange to meet up with a potential client (usually for an hour or so) so that we can discuss their past experiences, their hopes for this pregnancy, their concerns and most importantly so that they can get a “feel” as to whether they actually like and trust me.  Once a couple have decided to book me as their midwife I then usually give all their antenatal care in their own home (although I have done antenatal visits in The Bank of England medical room!).  The format of visits is that I carry out all the usual blood tests, urine and blood pressure checks, but also leave a lot of time for discussion so that over the course of the pregnancy we cover issues such as waterbirth, Vitamin K, when to call me and so on.

My clients come from a wide area – I am happy to take clients who live within approximately an hour’s radius of my home in Leighton Buzzard – so I do spend a fair bit of time driving, as well as liaising with G.P.’s and hospitals where necessary.

Four times a year I jointly organise an Antenatal Exhibition, this is an opportunity for pregnant couples to gather information about breastfeeding, pregnancy yoga, cloth nappies and the like.  We also organise Birth Preparation Workshops and am often to be found at the Community Desk in Central Milton Keynes on hand to speak to expectant parents and also regularly attend Study Day’s and midwifery meetings to ensure that I keep myself up-to-date with current research.

Obviously I spend much of my time being “on-call” for births.  My own family are now pretty much grown-up and the commitment isn’t as big as one might imagine as I rarely have more than two births during a month – it is important that I don’t over-commit myself as the whole point of what I do is that I guarantee to be there for the birth.  Babies don’t always read the text books though!  I have had three births in one week, as of course some babies do come early and some come late!  As you will appreciate, the birth is the big event, and it can on occasion go on for some time.

Baby being here doesn’t mean that my job ends!  In fact, postnatal visiting is often one of the busiest times as the family may need quite a lot of support in the early days.  The majority of my clients choose to give birth at home; however some either need to, or choose to give birth in hospital.

I visit my clients for up to four weeks postnatally and it is a joy to see the baby thriving and although discharging clients is always tinged with sadness it is also great to know that I have played a part in helping the family on to the next stage of their life.  (I do usually keep in touch, perhaps not as often as I would like, but I often get e-mails and photographs and usually pop in when I’m passing!).

So, in summary I guess the main differences between me and an NHS midwife are that you are buying my time; antenatal visits usually take around an hour and a half (instead of perhaps 10 – 15 minutes at your local surgery), are arranged more frequently and take place at a time and place to suit you. Most importantly you will receive full continuity of care – I will see you at each visit to build our relationship and plan your care and you will know that (barring exceptional circumstances) I will be with you in labour and available 24/7 for urgent help.

I am always happy to discuss anything that you are concerned about; please do feel free to call.

Written by Valerie Gommon, BA (Hons), RM, Independent Midwife

www.3shiresmidwife.co.uk 01525 385153

I guess the first choice is where do you want to give birth, at home, in a birthing centre or in a hospital?  Although you may be asked this at your first appointment you can actually decide at any time, even when you are in labour (although it may be easier if you make plans earlier).

There are so many factors to take into account, but the most important thing is to give birth where you feel safest.  Labour is a very instinctive, hormonal event and if you are scared or unhappy with your environment you will not labour so easily.

Homebirth:

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

Birth Centre/Midwifery Led Unit:

These are often seen as a half-way house between home and hospital.  They have many of the benefits of home, a more relaxed environment but if you are concerned about the privacy aspect of birth (for example if you live in a shared house, or are concerned about the neighbours) or the mess (which in reality is rarely an issue) then a birth centre may be right for you.

Birth Centres are only an option for women whose pregnancy is defined as “low risk” which means that the birth is expected to progress without complication.  Should a complication occur you will need to be transferred into a hospital where more advanced help is available.

Hospital:

Many women choose to give birth in hospital because they believe it to be the safest place.  Of course it is true that the hospital will have advanced facilities if needed however you should also bear in mind that sometimes these facilities are over-used and that just by setting foot in a hospital you increase your chance of using some of that help!  If you choose to give birth in hospital my top tip would be to stay at home as long as possible.

Waterbirth:

I think the use of water in a labour and birth can be hugely beneficial.  I recognise that not all women will want or need a waterbirth, but I would strongly recommend all women not to rule the use of water out.  It may be that you use water by having a bath or shower in labour; it can be hugely comforting to have shower water jetting onto your tummy or back whilst in labour.

As I see it, if we are achy or tense a bath is usually helpful.  It works in just the same way in labour; water is usually relaxing.  Another benefit is that women are much more mobile in labour and have their weight supported by the water making it easier to move around.  Lastly (dare I say it) if you are in a birthpool no one can interfere with you!  You are in your own space and are much more in control of what happens.

Most hospitals now have at least one birthing pool and if it is something that appeals to you I suggest you discuss it with your midwife and let the labour ward midwife know as soon as you arrive at the hospital.  For homebirths there is a considerable choice of birthpools available, for example rigid “bath” type pools that come with and without water heaters and inflatable pools.

Active birth:

Most midwives will agree that by being as active as possible you give yourself the best chance of having a normal birth.  In early labour listen to your body – if you can rest then do so, if you can eat then have something to eat and also make sure you drink plenty and pass urine frequently.  As the labour progresses keep changing position as your body directs; some women want to squat, be on all fours, pace around … most importantly change your position don’t just take to bed.  Being active and gravity will help you baby find its way through your pelvis and may well shorten your labour.

Antenatally it is helpful to prepare for the labour by undertaking gentle exercise, perhaps walking, swimming or yoga.  I wish you a lovely birth wherever you decide it should be!

No two pregnancies are the same, so it is very important that you continue to look after yourself by eating and resting as much as you possibly can.  Remember this time you are also looking after your little one(s) too.  You may feel better or more tired this time around; and certainly having a toddler is hard work.  If your toddler sleeps then you should rest and not rush around doing housework!  If you are exhausted try asking a friend if they would have your toddler for a couple of hours so you can rest.  I can’t stress enough that you need to eat a good diet – ensure that you eat plenty of protein and iron rich foods.

You may notice that you “show” earlier second time around, this is because your tummy muscles have been stretched before and is quite normal.  You may also notice baby movements a little earlier because you know what you are looking for, but don’t worry if you don’t!

Some women say that they are anxious about labour second time around; if you had a difficult labour talk to your midwife about it – ask her what happened and why it happened and what are the chances of it happening again, however second births are usually much easier and shorter.  It is usual to be a bit anxious about labour – most women are, but remember you did it last time and you can do it again!

I think it is definitely worth attending childbirth classes if you can – I had four children and I went to classes each time – it gives you time to concentrate on this pregnancy and this new baby; and a birth plan is a great idea, second time around you are better prepared as you know what to expect, you know what you want and don’t want to happen so put it down into a birth plan and if you need advice speak to your midwife.

Successive reports have called for one-to-one care in labour as all outcomes are improved, for example women are more likely to have a normal birth if they receive one-to-one care.  However, to some women this means having the same midwife from booking, through the antenatal period, labour and birth and until postnatal discharge – this type of care may not be available in your area unless you employ an Independent Midwife www.independentmidwives.org.uk.

Consider having your baby at home, there are so many benefits, women usually have shorter and easier labours and this time you will be better able to read your body and can stay at home if you feel comfortable and relaxed and you won’t have to leave your first child whilst you are in hospital.  Staying upright and active will help with the contractions and also keep the baby in the best possible position for birth, but your body will tell you what you need to do; try to relax and have faith in the birthing process.

Women generally recover quicker second time around, this is partly because labour is usually quicker and easier – and also because being an experienced mother usually helps to establish feeding more quickly.

Unfortunately, the more babies you have, the stronger the after pains usually are – this is because your uterus is having to work harder to contract.  Ask for paracetamol which will help and is perfectly safe to take.

Remember that your other child(ren) will need extra love and reassurance – your new baby is much tougher than you think, try to involve the older sibling(s) in what you are doing and have patience – it is usual for children to regress a bit when they have a new baby in the house.  Accept any help that is offered and consider staying in your pyjamas for a few days – it shows that you are not at full strength.  I think women try too hard to be superwoman, just allow yourself some time to enjoy your new baby – they aren’t babies for long, although it sometimes feels like it when you are in the thick of it!


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