Valerie Gommon Midwife’s Blog

Archive for the ‘blood tests’ Category

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/

This item is reproduced (with consent) from Birth Sense a common-sense guide approach to normal birth www.themidwifenextdoor.com/?p=747.  In the UK we sometimes use a large Lucozade drink or a heavy sugar syrup drink, and we probably wouldn’t do four blood tests, probably only two, however, this test is increasingly being used for all pregnant women in the UK and I agree with the points raised in this article.  It is certainly worth discussing whether you want/need the test with your midwife.

“Of all the tests pregnant women are expected to endure, glucose testing is probably the most dreaded.  Women groan, and tell me they’ve heard horror stories from their friends about how sick the drink will make you feel, or how they couldn’t hold it down.  There are two types of glucose tests.  The first involves drinking a sugary, flat soda type of drink (called a glucola), then getting your blood sugar levels drawn one hour later.  This is a screening test only, and helps practitioners decide who needs the three-hour test.  The three-hour test involves drinking a sugary drink on an empty stomach (after fasting 12 hours), and getting four blood draws: one before you drink the glucose; and subsequent draws at one, two, and three hours after drinking the glucose.  Having elevated blood sugars on any two of these four draws confirms a diagnosis of gestation diabetes.

The mystery to me is why glucose testing continues to be performed on nearly ALL pregnant women, regardless of risk factors.   The American Diabetes Association recommends categorizing women into high-risk, average-risk, or low risk groups.

High risk women are those who begin pregnancy with a high body mass index (BMI), have a personal history of GDM, or have a strong family history of diabetes.   Other risk factors include older maternal age (over 35) and African-American, Native American, or Hispanic ethnicity.  These women should be screened in early pregnancy, and again at 24-28 weeks.

Low-risk women, who do not need to be screened, are under age 25, normal weight at onset of pregnancy, do not belong to a higher-risk ethnic group, and have no personal history of GDM, poor obstetric outcome, or family history of diabetes in a first-degree relative.

Women of average risk, who are not in the high risk category, but don’t meet all the criteria for low-risk women, should be screened at 24-28 weeks.¹

However, evidence to support these recommendations is lacking, according to the Cochrane Review and the United States Preventive Health Taskforce (USPHT).  The USPHT recommends, “Until there is better evidence, clinicians should discuss screening for GDM with their patients and make case-by-case decisions. Discussions should include information about the uncertainty of benefits and harms as well as the frequency of positive screening test results.”²

When is the last time a pregnant woman receiving typical modern obstetric care was treated on a case-by-case basis?  Most women are treated with cookie-cutter, one-size-fits-all obstetric care.

A recent study found that testing fasting blood sugar by a simple finger-stick (which a woman could do herself at home) may be just as predictive of women who need a three-hour glucose screening as the one-hour test.³  Additionally, there are other tests which are alternatives to the one-hour test, and may be  more appealing to some women.4  These tests include a pancake breakfast, or eating a specified number of jelly beans.  Concerns about these tests as substitutes are that they may not  be as accurate as the one-hour glucose in predicting which women need the three-hour test, but they are used in government health agencies, including the Indian Health Services, which serves a high-risk population.

Many of my clients say to me, “I don’t eat refined foods when I’m pregnant, so why should I drink a big glass of refined sugar?”  The politically correct answer is, “So we can have an ‘approved’ diagnosis of gestational diabetes.”  But many women would prefer not to take the glucola test, especially if they are already very health-conscious and physically fit.

I have also worked with clients by loaning a glucose meter that is calibrated to simulate identical blood sugar levels as when you get your blood drawn from your arm.  They can check a fasting blood sugar when they first wake up in the morning, and then blood sugars two hours after a typical meal, on two or three different days and times.  I believe this provides a more accurate picture of how the woman’s body is handling her normal diet, although I admit it does not give us the “official” diagnosis of gestational diabetes.

Common-sense tip for today:  Talk with your provider about the USPHT recommendations.  Are you at increased risk for GDM?  Then consider testing, whether it is glucola or an alternative.  Are you at low or average risk?  You may wish to consider skipping testing, unless it seems that the baby is growing faster than usual, you are having consistent problems with sugar in the urine, or you are experiencing symptoms such as jitteriness/dizziness/nausea.

1.  American Diabetes Association.  Gestational diabetes.  Retrieved 03/25/10 from:  http://www.diabetes.org/diabetes-basics/gestational/

2.  National Guideline Clearinghouse.  Screening for gestational diabetes mellitus.  Retrieved 03/25/10 from: http://www.guideline.gov/summary/summary.aspx?doc_id=12507&nbr=6437&ss=6&xl=999

3.  Agarwal MM, Dhatt GS, OthmanY, Gupta R.  Gestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk population. Diabetic Medicine, 2009.  Retrieved 3/13/10 from: http://www.ncbi.nlm.nih.gov/pubmed/19709144?dopt=Abstract

4.  Indian Health Services. Alternatives to oral glucola testing.  Retrieved 03/15/10 from: http://74.125.95.132/searchq=cache:EWcHFJkuecMJ:www.ihs.gov/MedicalPrograms/MCH/M/documents/AltGlu4505.doc+IHS+alternative+glucose+testing&cd=1&hl=en&ct=clnk&gl=us


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