Valerie Gommon Midwife’s Blog

Archive for the ‘antenatal’ Category

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.

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Another Guest Blog from Sheila Sheppard, Nutritional Therapist.

We know that a baby is nourished in the womb not only by what its mother eats during pregnancy, but also by her body. It’s important, therefore, to be well nourished prior to, throughout and beyond pregnancy to protect your own health.

Here is just one example of how important it is for you to meet your baby’s nutritional needs as well as your own, throughout pregnancy and beyond.

Three weeks after conception, your baby’s brain begins to form, and continues to develop rapidly throughout your pregnancy. The brain is 60% fat and the two most important components are DHA (an omega-3 fatty acid from fish) and ARA (arachidonic acid, from meat, eggs and dairy). These fats are transferred across the placenta and are also present in human milk; they are accumulated in the brain and retina during foetal and infant development.

Most of us consume plenty of foods with ARA so this isn’t usually a worry, unless mum is vegetarian or vegan. Omega-3 is another matter though, as many people don’t eat any fish at all, or avoid oily fish such as salmon, pilchards, sardines, mackerel and tuna.

In her third trimester, the mother needs to eat foods rich in DHA: the placenta takes DHA from her blood and concentrates it in the baby’s circulation; the baby’s DHA level is now double his mother’s.  If she has low blood levels of DHA (because she’s not eating much – or any), DHA is also taken from the richest store – her own brain.  This may account for the slight shrinkage of women’s brain cells and the poor concentration experienced during late pregnancy. The baby continues to need DHA in his milk up to around 4 months and mum needs to keep up a steady intake to protect her own stores of DHA while making sure baby gets enough too.

Research shows that deficiency of omega-3 fatty acids in pregnancy and beyond is linked to post-natal depression, and to behavioural, learning and visual difficulties in children.

Oily fish is recommended 2-3 times per week, and if you can’t manage this then you should seek professional recommendation of a fish oil supplement with good levels of DHA; vegetarian DHA supplements are made from algae. You could also enjoy a regular serving of home made taramasalata (made from fish eggs), a recipe for this is on my website www.nutribaby.co.uk/recipes.php. If you’d like to know more about nutrition in pregnancy, for infants or for weaning, please get in touch.

 

Sheila Sheppard Dip NT, mBANT, CNHC

NutriBaby

Sheila@nutribaby.co.uk

07799 132999

16th April 2012

A guest blog written by Moira D’Arcy, Women’s Health Physiotherapist at St Judes Clinic, Leighton Buzzard.

Protecting Your Back During Pregnancy

During pregnancy changes in your body can affect your back and your posture.  As the weeks pass your weight is no longer centred in the middle of your pelvis but moves forward with the weight of the growing baby.  For most women their posture adapts to compensate for this shift and you may find yourself either slumping forward and flattening out the curve in your low back, or counter balancing the weight by leaning back, at your upper body, which leads to a greater curve and a shift of your weight on to your heels.  The muscles of your back, lower abdomen and your pelvic floor are designed to move and stabilise the joints in your back and pelvis but as your baby grows they are put under more potential strain.  This, along with the adaptations you may make to your changing shape, combined with hormonal (hormones are chemicals that carry messages around your body) changes that loosen the ligaments around the pelvis, can result in low back pain, upper back pain, pubic bone discomfort and general postural strain.

What can you do to reduce those risks?

Stand Tall – imagine that someone is making you feel taller by pulling a string attached at the back and top of your head at the same time as you tightening your tummy muscles and pelvic floor as much as you are able.

Sit Correctly
– make sure your back is well supported. You may prefer a dining chair to a soft chair or sofa.  Placing a small rolled up towel in the hollow of your back may help if you are finding your back is adopting a flattened posture.

Avoid Heavy Lifting
– Your loosened ligaments make them vulnerable so ask for help whenever possible.  If you do have to lift, make sure you hold the object close to your body, and bend your knees rather than your back.  If you are shopping divide your goods into equal loads for each hand.

Wear Comfortable Shoes
– Generally, if you are finding the curve in your low back increasing, flat shoes may be more comfortable as heels will accentuate the curve.

Adapt The Way You Carry Out Your Chores
– eg when vacuuming stand in a walking position, with the Hoover in front of you, then move your feet to the next area and Hoover in front of you again.  Don’t be tempted to push it so far away from your body that you end up bending and twisting your back.

Exercise Regularly
– but unfamiliar routines may damage the joints that loosen during pregnancy so it is wise to seek advice if you are unsure of the suitability of your exercise regime. The most appropriate forms of exercise include swimming, walking, aqua natal classes, Pilates and yoga.  It is important that the instructor is qualified or experienced in teaching pregnant women.  If you are experiencing pelvic girdle pain, or symphysis pubic dysfunction, then always seek advice from a Chartered Physiotherapist prior to beginning any exercise.

You can reduce the risks to your pelvic area and pubic joint by:

 

  1. Standing evenly on both feet.
  2. Sitting on both buttocks and not crossing your legs.
  3. If you have other small children don’t carry them on one hip.
  4. Avoid movements where you are swinging your leg sideways, for example when you get in and out of bed, or a car, turn your hips, pelvis and back in the same direction, while keeping your back straight, so you are moving as a whole and not twisting.

Once your baby is born there is a period of time, while your hormones re-adjust and you resume your usual tasks, when your spine remains susceptible to damage.  This may even be increased by a busy, unfamiliar schedule involving lifting and carrying car seats and prams, combined with feeding postures, picking baby up from their crib and carrying them. It is important to protect your back in the same way you did when you were pregnant.

If you find you cannot resolve your discomfort with this simple advice seek the help of a Chartered Physiotherapist who will be able to identify your specific problems and aggravating activities.  They can then provide you with a tailored programme that will fit in with your schedule.  They can also advise and provide you with supports to relieve/reduce low back pain and pelvic girdle discomfort. 

This information is provided by St Judes Clinic and is intended as general advice during and after pregnancy.  For more detailed advice please book an assessment with us or seek further medical advice from your GP.

Moira D’Arcy  Grad Dip Phys MCSP AACP APPI

Practice Principal

St Judes Clinic

26 Lake Street

Leighton Buzzard

LU7 1RX

Tel: 01525 377751

E-mail: enquiries@stjudesclinic.com

http://www.stjudesclinic.com/health/pregnancy/

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’ve just been listening to the latest episode of The Archers where Helen has just had an emergency caesarean section for pre-eclampsia and thought that it would be a useful subject to write about.

I think it is fantastic that the subject has been covered by the radio programme and on the whole they have got it right (wouldn’t expect anything less from The Archers!) but I would like to add a bit more.

Pre-eclampsia is a potentially serious condition of pregnancy that we are still learning about.  For serious pre-eclampsia the only treatment is to deliver the baby (sometimes prematurely), however for most pregnancies the pre-eclampsia can be monitored and the labour may well start normally and spontaneously, or the labour may be induced around your due date and you may well have a normal birth.

Pre-eclampsia is one of the things that your midwife is looking for antenatally and is usually characterised by a collection of symptoms: raised blood pressure, protein in your urine, swelling (oedema), headaches, visual disturbances and upper abdominal (epigastric) pain.

Many women will experience one or more of these symptoms without developing pre-eclampsia, but if you have two or more symptoms or feel concerned you should definitely speak to your midwife urgently.  For example many women will have a headache or some swelling and this is normal during pregnancy – it is usually only when you have several symptoms that pre-eclampsia is suspected and you will then be referred to hospital for further investigations including blood and urine test and monitoring of the baby’s wellbeing.

Women at increased risk of pre-eclampsia include:

  • Those in their first pregnancy
  • Having high blood pressure
  • Having certain blood clotting disorders, diabetes, kidney disease, or an autoimmune disease like lupus
  • Having a close relative (a mother, sister, grandmother, or aunt, for example) who had preeclampsia
  • Being obese (having a body mass index of 30 or more)
  • Carrying two or more babies
  • Being younger than 20 or older than 40

However if you fall into any of these categories you are still more likely NOT to get pre-eclampsia.

There is some evidence (though not mainstream) that pre-eclampsia may be prevented by eating a really healthy diet and by increasing your protein and salt intake.  It may also be beneficial to stop work slightly earlier in your pregnancy and not to overdo things at the end of the pregnancy.

More information on the dietary aspect can be found at https://midwifevalerie.wordpress.com/2009/08/04/dietary-suggestions-for-pregnancy-from-tom-brewer/

MATERNITY, PATERNITY, ADOPTION PAY & SSP INCREASES

Standard rates of statutory maternity, paternity and adoption pay will increase from £124.88 to £128.73 per week from 3 April 2011. Statutory sick pay will also increase from £79.15 to £81.60 per week from 6 April 2011.

REJECTION OF EXTENDED MATERNITY LEAVE

An extension to 20 weeks for maternity has been rejected by EU ministers The Council of the European Union has rejected proposals to extend the minimum period of fully paid maternity leave to 20 weeks, which the European Parliament voted for in October 2010.

CHANGE TO CHILDCARE VOUCHER RULES

It has been confirmed that there will be changes to the tax law regarding the childcare voucher schemes in 2011.  The Government’s view is that there are too many well-off parents benefiting from this and this will lead to a change in the way that the system will work.

Employees wanting to take up vouchers have until 6th April 20111 to sign up.  If you are an employer thinking about implementing a scheme, do so now.

Information provided by:

Sandra Beale FCIPD
SJ Beale HR Consult Ltd
Tel: 07762 771290
Email: info@sjbealehrconsult.co.uk
Web: http://www.sjbealehrconsult.co.uk

It has been confirmed that there will be changes to the tax laws regarding the childcare voucher schemes in 2011. The government view that there are too many well-off parents benefitting from this (including tax-free music lessons through certain schemes) will lead to a change in the way the system will work. Employees wanting to take up vouchers have until 6 April 2011 to sign up. If you are an employer thinking about implementing a scheme do so now.

It has been confirmed that there will be changes to the tax laws regarding the childcare voucher schemes in 2011. The government view that there are too many well-off parents benefitting from this (including tax-free music lessons through certain schemes) will lead to a change in the way the system will work. Employees wanting to take up vouchers have until 6 April 2011 to sign up. If you are an employer thinking about implementing a scheme do so now.

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!


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