Valerie Gommon Midwife’s Blog

Archive for the ‘breastfeeding’ 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

In a paper published yesterday in the British Medical Journal researchers from the University of London Institute of Child Health (UCL) claim that relying purely on breastfeeding for the first six months might not be best for babies. Interestingly, the study “acknowledges that three or four of the authors have performed consultancy work and/or received research funding from companies manufacturing infant formula” which brings into question the validity of the research; a further criticism is that research needs to be population specific.

Today, many prominent organisations have spoken against this paper, however it is confusing for members of the public and undermines the work that midwives and others do to promote breastfeeding.

The current advice in the United Kingdom based on World Health Organisation guidelines, says that babies should be exclusively breastfed for 6 months however the UCL team say that weaning could happen as early as four months as it is claimed that the later weaning might increase food allergies and lead to nutrient deficiencies.  This statement is heralded as a “retrograde step” by the Royal College of Midwives professional policy adviser Janet Fyle and others.   Indeed a Department of Health spokeswoman said: “Breast milk provides all the nutrients a baby needs up to six months of age and we recommend exclusive breastfeeding for this time. Mothers who wish to introduce solids before six months should always talk to health professionals first.

In summary the current best advice is to exclusively breastfeed for six months and then to continue breastfeeding with food supplements for at least a year.

Further discussion can be found at:
www.guardian.co.uk/lifeandstyle/2011/jan/14/breastfeeding-comment-joanna-moorhead

I have recently had a client whose baby had ankyloglossia and needed a tongue-tie division (or frenulotomy), the baby was having some difficulty with breastfeeding, and the mother was experiencing nipple soreness despite good positioning.

Tongue-tie may be hereditary and is a condition where there is a short or tight membrane underneath the tongue; it can be hard to diagnose and is easily missed. The skin “tie” can be attached at the tongue tip or further back and as a result the tongue-tip can appear heart-shaped; the tongue movements to lift, move from side to side and protrusion can be restricted and this may affect the way the baby feeds.  A recent study found that of babies having feeding difficulties up to 10% had a tongue-tie.

What should you look for?

You may experience pain on breastfeeding your baby, your nipples may become damaged and you may develop mastitis or find it difficult to establish an adequate milk supply (although all these symptoms can relate to positioning issues too).

The baby may have difficulty feeding and may need to feed frequently and for prolonged periods of time to be satisfied. There may also be weight problems, noisy feeding, dribbling and increased windy behaviour (although again your baby could have these symptoms without tongue tie).

Some babies can feed perfectly well despite having a tongue-tie and adjustments to positioning and attachment may be all that is needed if there are problems with feeding.  It is definitely advisable to seek specialist breastfeeding support such as La Leche League, National Childbirth Trust, Association for Breastfeeding Mothers or Lactation Consultants GB and if the problem continues despite this support then tongue-tie division or frenulotomy is an option. You may be able to get an NHS referral from your local breastfeeding clinic or GP; hospitals providing this treatment are listed on the Baby Friendly website, however there are also private practitioners who will perform this for you and some of them are listed at the end of this article.

Should it be decided that a frenulotomy is necessary, the procedure is very simple and takes a few seconds.  Your baby is swaddled and held gently to keep the head still. The tongue-tie is snipped using sterile, sharp, round ended scissors without the need for an anaesthetic; your baby may feel a small amount of pain but will usually settle quickly and will be able to feed, indeed some babies actually sleep through the procedure!  There is usually very little bleeding and any oozing is controlled by applying pressure to the area with sterile gauze and encouraging feeding as soon as possible.

Good information on tongue tie can be found here on the Lactation Consultants GB website.

www.chilternbreastfeeding.co.uk/tongue_tie_division.html

www.ann-dobson.co.uk

www.mosshealthskills.co.uk/denise-pemberton.htm

www.hampshirehomebirths.co.uk

 

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!

Another guest blog by Sarah:

Harlow Zen’s Birth Story

Harlow is my third baby having had Rohan 9 years previously and Nayt almost 8 years ago.  With Rohan I was induced at 10 days late, in hospital, with an epidural given as I was told he was back to back and it would be too painful, I ended up after 17 hours flat on my back, with a nasty tear and a pretty miserable painful experience to tell but a beautiful baby nonetheless.  I had Nayt 16 months later and keen to never set foot in a hospital again, we used 2 Independent Midwives and had an amazing natural home water birth, in less than 4 hours with no pain relief, no stitches and 23 days late! I was out and about within days, a completely different experience to my first. Both babies were reasonable sizes at 8lb 13oz and 9lb 2oz respectively.

With Harlow, because he was my husbands first and I was a bit rusty having had a good few years off baby making, we decided to use another Independent Midwife as the 1-2-1 care is like nothing else, and gives you the confidence that you will get the best birth outcome and overall experience possible, as they really get to know and understand you.  As my pregnancy progressed it was clear this baby was going to be on the large size, which I had kind of expected. I was advised to cut down on sugar but with a massive cake craving, this didn’t really happen, so I tried damage limitation by continuing to ride as long as I could and towards the end to swim daily and keep up with walking the dog.

I think my confidence in giving birth was knocked a bit towards the end because I had to have a series of late scans to check the placental position, as was slightly lying low at the 20 week scan. This showed up that at 34 weeks the baby was the size of a full term baby. I am reasonable at simple maths, and that added up to one BIG bubba!!

Because of this, I was told to expect an early baby. Unlike my other two pregnancies where I had no pre-labour signs whatsoever, I was starting to get runs of proper contractions about 3 weeks prior to my due date. I had so many signs in fact that I have decided there are no signs until the baby is literally crowning!! Along with contractions, I was nesting, had a show,  had a permanently bad tummy, babies head engaged….never happened to me before labour with the other two, bump shifted down….and then my due date came and went…and my bump un-engaged and shifted up!!!

On Tuesday 18th May after my husband Adam had taken the kids to school I started to get decent contractions. I really felt like today was the day. By midday they had gone, and annoyed I took my dog on a hill walk hoping to jolt the baby out with some gravity! Nothing! I was really sure that was it too, as my dog Phoebe had been all over protective, following me around and sleeping beside me wherever I went.

They started again around 11pm, but having sent our midwife numerous ‘I think its started’ texts over the last few weeks, decided to sleep on it.  At 1.55am Wednesday 19th May I woke up with a jolt as my waters literally burst all over the place. I managed eventually to wake my husband up who had fallen asleep on the sofa downstairs and after a massive clean up operation we called our midwife Valerie and she came out straight away.

The contractions had stopped but restarted around 3am and were roughly every 3 mins, reasonably painful (a 5-6) but not lasting too long. We all tried to get some sleep at 6am, but the contractions slowed down a lot.  By the time my kids woke up and we had agreed they could take the day off school, they were back to quite painful and we all thought finally ‘this is it!’. By about 9.30am I got into the birth pool my husband had busied himself filling and my labour ground to a halt and slowed down. My parents came and took the kids out for lunch as it was my Dads birthday, and gave me a bit of space and peace. At 1pm-ish we asked Valerie to examine me and I was disappointed to find I was barely dilated, and all that pain and hard work had merely helped Harlow to get into a better position.  Valerie left for home and me and Adam went for a walk, had some lunch and then at 5.20pm decided to get some sleep.  My kids were sent off to their rooms to watch a film.

At this point I was feeling despondent and was sure my pain threshold was rubbish. I started soon after to get contractions every 8-9 mins, lasting almost 2 mins and they were really painful. The peaks seemed to last for 40 seconds before subsiding. By almost 7pm I was crying and convinced I was still about 3 cm dilated.  I got very emotional and was convinced I would end up in hospital with a c-section. Adam was amazing and really supported me. He suggested we call Valerie, who had just text me. She came out with the entonox and as soon as she arrived I was getting the urge to push. I was on all fours and could not move into any other position…how I got downstairs I have no idea!!!

I managed to get downstairs and Adam re-filled the pool which we had drained down partially earlier.  I got in, and contractions were very close, strong and the peak lasted ages. Adam was great and helped me get the gas and air when I needed it, and provided emotional support as well as an arm for me to dig my nails in (sorry Adam!!), and Valerie helped me to get past the panicky ‘I cant do this’ with encouragement that I could really trust in.  At 8.20pm I could feel Harlow move down and he was born in the birth pool at 8.40pm. Valerie had called my kids down and they both watched their little brothers entrance into the world.

Harlow was born behind me, so with some jigging I was able to climb over my cord and hold him.  He cried a little and had a feed quite soon afterwards.  He was covered in vernix and his skin felt so soft.  He looked just like 3d scan picture and apparently my first words were ‘Hello Harlow’.  Adam cut the cord after it stopped pulsating and Valerie tied the cord with a cord tie I made specially for the event, and as I delivered the placenta naturally an hour later, Adam, and the kids had all taken turns to hold Harlow and make their introductions. It was the most special sight ever and something they will never forget, nor will I.

At 10.30pm we sent the kids to bed, and after a glass of champagne with Valerie; myself, Adam and Harlow settled down for our first night together. Perfect.

We were all a bit shocked that Harlow tipped the scales at 10lb 6oz, and I got away with a tiny tear and a graze and no stitches!! It was a more painful labour than Nayts birth, and the longest overall labour, but an amazing experience that 5 days after the event makes me ask ‘when can I do it again’???.

Guest blog by Susan Quayle

I became interested in reflexology about fifteen years ago when I bought Laura Norman’s book, The Reflexology Handbook: A Complete Guide. At the time my sister-in-law was pregnant and had morning sickness so badly that she was bed ridden and under threat of hospitalisation. I got my book out and looked up morning sickness in the back and worked the reflexes it showed – having no real idea of what I was doing – and the result was instantaneous. She felt much better than she had for weeks.

It would be a further twelve years before I would work on feet again but this time it would be to train as a reflexologist. About a year after I’d qualified I received an email asking if I would be interested in attending a course in Maternity Reflexology. By this time I’d had two children and was the bearer of double C-section scars so was very interested in what maternity reflexology could offer the pregnant woman. I went along to the course expecting something amazing but not  really prepared for the actuality of how utterly brilliant reflexology is for pregnancy and labour. I came away thinking that Maternity Units were crazy not to have maternity reflexologists working alongside midwives or midwives trained as maternity reflexologists.

Reflexology is fabulous for for everyone but is utterly perfect for pregnancy and labour. They really go together like, like….mother and baby!

Apart from the very serious conditions that are potentially life threatening to mother and/or baby there isn’t a pregnancy related condition that can’t be alleviated and, more impressively, prevented with reflexology. Because pregnancy isn’t an illness but a temporary condition the usual parameters relating to conditions such as oedema, constipation and other digestive related problems, even gestational diabetes, are different from at any other time and if caught in time respond extremely well to reflexology. I say caught in time because some conditions such as oedema need to be treated early as they worsen on a daily basis.

During a treatment mums drift off into deep relaxation, babies squirm excitedly before relaxing with mum into a blissful baby/mummy zone of bonding. During this relaxation blood pressure reduces, energy is restored and reserved, anxiety levels drop and a sense of self and safety permeates the body. Reflexes are worked to balance the internal organs and systems of the body and allow the free flow of blood and energy to every cell of their being. I am always amazed at how early in pregnancy it is possible to feel the subtle changes that take place in the mother’s body – usually the liver and spleen reflexes as the volume of blood increases to produce the growing baby’s blood supply.

I have had many successes with morning sickness, heartburn and fatigue, SPD, constipation, reducing blood pressure, oedema, early onset labour (this treatment was to stop labour at 33 weeks), re-starting labour 5 hours after it had stopped, lack of sleep, discomfort, positive mental attitude toward the growing baby and also toward the mother’s own body image. Regular treatments can also result in a faster labour with less need for pain relief – studies have been done to back up these claims. Women I have treated with regular treatments feel very in touch with their babies and their pregnancies, they tend to say that their labour was easier than previous ones and that they felt more relaxed about the whole experience. They also say that their babies are very relaxed and laid back and that both mother and baby have found breast feeding much easier than in previous births. Reflexology promotes healthy pregnancies, healthy mothers, faster births often with less need for pain relief, happy mothers and happy babies.

I often feel great sadness that I didn’t know about maternity reflexology when I was pregnant as both my birth experiences were over-medicalised and with the use of reflexology might not have been. So this is the message that needs to get out there to all pregnant women – there is help out there to complement and work alongside normal medical practices. You are not ill – you are pregnant and you are doing what your body was made to do. Reflexology can help you to have a happy, healthy pregnancy and baby.

Susan Quayle is a Complementary Therapist based at the Exeter Natural Health Centre in Devon. She is a founder member of Maternity Reflexology South West who work tirelessly to promote maternity reflexology. She lives with her husband, two children, cat and chickens.

To find out more about her visit her website at http://www.lovereflexology.co.uk

I guess this may be more useful if you are planning to hire an Independent Midwife as with the NHS there is less choice, but you still do have a choice of midwife and should remember that if you don’t get on with your midwife you can ask the local Supervisor of Midwives (at the local maternity unit) to help you to find a new midwife.

If looking for an Independent Midwife, I would suggest that you start by looking at www.independentmidwives.org.uk where you can enter your postcode to find the midwives who live closest to you.  This website will then lead you to look at the midwives own websites and you should get a “feel” of the midwives from their websites.  The next step is to email or telephone your favourite midwife(s) to have a chat with them, again this should help you to gauge whether they might be the right midwife for you.

The midwife will want to know where you live (to ensure that she is able to travel to you), she will also want to know when your baby is due (to ensure that she is free at that time) and whether it is your first baby.  If you have had a baby/babies before I would expect her to ask about your experience.  She will also be keen to know where you plan to give birth.

Questions you may like to ask of the midwife include:

How long have you been a midwife? / An Independent Midwife?
Do you like homebirths/waterbirths?
Do you have additional skills (hypnosis training etc)?
What would happen if my baby is breech/I am expecting twins?
What is your normal birth rate?
What is your caesarean rate?
What is your breastfeeding rate?
What is your homebirth rate?
What is your transfer rate?
How much do you charge?
What can I expect from you?
Antenatal care? Labour and birth care? Postnatal care?

I would expect an Independent Midwife to outline the issue of the lack of professional indemnity insurance to you.

If you enjoy speaking to the midwife, I would suggest that the next course of action might be to arrange a consultation.  The midwife will usually be happy to come to your home to meet you and your partner to discuss things in more detail.  Many midwives make a small charge for this meeting to cover their time and petrol costs (this meeting make last a couple of hours) and will be an opportunity for you to ask any questions of the midwife and again to enable you to decide whether she is the right midwife for you.  Most midwives will deduct this fee from the final balance if you decide to book with them.

Some women do “interview” a couple of midwives, and this is perfectly acceptable and perhaps a sensible approach as it will be an important relationship.

An Independent Midwife’s fee may seem expensive, particularly when you can get a similar service for free on the NHS, but I always say to clients that you won’t have many babies and it is important to get things right!  It may be better to employ a midwife and wait a bit longer for the new car or foreign holiday!  An Independent Midwife will usually give you a lot more time than an NHS midwife is able to; she will see you more frequently and give you longer appointments.  The other main benefit is that you will see the same midwife throughout your pregnancy, birth and postnatal period.

I wish you well in your decision-making whether you choose an NHS or Independent Midwife, and if I can be of any help to you please feel free to email info@3shiresmidwife.co.uk


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