Valerie Gommon Midwife’s Blog

Archive for the ‘Breech birth’ 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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This is a guest blog, written by one of my clients.

My name is Donna and I am a mother of three.  Two year old Grace and nine week old fraternal twin girls Olivia and Faith.

My husband Paul and I had always agreed that we didn’t want a big age gap between our children so when Grace was one year old, we decided to begin trying for baby number two.  I fell pregnant fairly quickly but unfortunately suffered a miscarriage at 5 weeks which was very upsetting.  After a few weeks we were ready to try again and as before, I fell pregnant within a couple of months.

I was very anxious during the first few weeks hoping that this time I would hold onto the baby.  At 12 weeks it was time for the scan.  I was feeling quite relaxed as the pregnancy was going well and I was feeling extremely sick which I thought was a good sign.

The last thing on my mind was the fact that I could be carrying twins.  When the ultrasonographer casually told us ‘oh, you have two in there’, we knew that our lives were going to change forever.  I didn’t know whether to laugh or cry – so I did both!  Everyone in the room was so excited for us but my husband and I were just stunned.  His face was a picture.  They told me that the reason why I had felt so sick was due to the additional hormone racing round my body. They also told us that the twins were fraternal and each had their own placenta and were in their own sac which is the safest type of twin pregnancy.

The first feeling I had once I had calmed down was that of being pregnant for the first time.  My pregnancy suddenly went from having a singleton baby and feeling confident that I had done this before so it will be ok, to all the anxieties of a first time pregnancy.

I knew that I had to do my research so as I could make some informed decisions about my pregnancy and birth.  When I told the ultrasonographer that I was planning a home birth, her reaction was ‘oh, you won’t be able to do that with twins’.  I had a fantastic pregnancy with Grace and had her at home in a birthing pool.  The thought of having to follow a medical route and have my babies in hospital filled me with dread.

As with my first pregnancy, I chose to take on an independent midwife.  This was my preference as I knew I would be less likely to end up with a hospital birth.  I made sure I looked after myself by eating well, getting plenty of rest (as much as Grace would allow me!) and exercised regularly.  I found swimming was great for keeping me fit and taking the weight off my bump.  I had regular scans to check on the twins’ development and position.  Throughout the pregnancy, Olivia (first born) remained head down and Faith was breech.  I knew that this wasn’t ideal but also knew after doing some research that as long as Olivia remained head down and although a little more risky, I could still safely deliver Faith as breech.  At 38 weeks I went for my final scan and to my surprise, Faith had done a full turn and was now head down along with Olivia.  The perfect combination for birth.

We had put together a birth plan that covered every eventuality if I needed to be transferred to hospital at any stage.  Two days after my last scan; my waters broke at 9.30pm when I was lying in bed.  I felt a pop and then a head drop down.  I walked into the bathroom and called downstairs for Paul saying ‘I think my waters have broken!’  He chased upstairs and I told him to call the midwife.  My contractions started almost immediately after my waters broke.  I spoke to my midwife and she told me to go back to bed as things may not start to happen until the morning and I would need my rest.  Olivia was not going to wait until morning.  I came downstairs and stood in the bathroom leaning over the toilet with my contractions coming fast and furious.  I tried the TENS machine but that didn’t really work for me.  Paul was in the dining room putting together the birthing pool which I got into as soon as it was ready.  The relief was immense.  I had heard that water was the most effective pain relief next to an epidural – I can well believe that.

I had four midwives looking after me and the babies and they all arrived at my house in time.  It was all happening so quickly and Olivia was born in the pool at 11.55pm.  She shot out and I heard her crying straight away.  I stood up and held my baby; I was elated and also amazed that my babies would have their own birthdays.  One of my midwives held my stomach to make sure that Faith fell and engaged in the right position.  We knew she was head down so we needed to make sure she stayed that way.  We decided to wait for my labour to progress naturally however, it slowed down.  I got out of the pool to walk around and see if I could get it started again.  Four hours passed and a decision was made to break the waters around Faith as the midwife discovered they were still intact.  As soon as the waters were broken, Faith was born on the sofa, again extremely quickly.

She cried straight away and the midwife placed her on me so as I could give her a cuddle and have skin to skin contact.  Another of the midwives was looking after Olivia.  Both my babies were born healthy and I couldn’t have been happier than I was just then.

The down side was that I now had to deliver the placentae.  I was so tired but knew I had to keep going.  One of my midwives helped to keep me relaxed with hypnobirthing techniques and control my breathing.  The placentae had fused together and were not budging.  With a combination of experience from my midwives and a hot towel placed across my stomach, the placenta moved and came away.  If it hadn’t been for the determination and skill of the team of midwives, I think I would have ended up in hospital with a retained placenta and that would have been disappointing after going through the entire birth at home.

So all was well.  I was in good health and although extremely tired, felt elated and proud that I had accomplished the birth I wanted.  My husband Paul was fantastic during and after the birth and I couldn’t have asked for a more supportive birthing partner.

A home birth is not for everyone and if there had been a health issue with either myself or my babies, I would have chosen hospital care.

I wanted to share my story so as other women can see that you do have choices during pregnancy even when you are having twins and you can make decisions that are right for you.  For more information about twin and multiple pregnancies visit www.tamba.org.uk

Donna has also set up a website which offers information about homebirth; she offers a free ebook at www.happyhomebirth.com

I know I’ve been quiet of late, not many blog postings.  This is mostly because I’ve been busy clinically, and I thought that today I’d share a recent experience of a breech birth with you.

I had previously cared for my client with her second baby – she had a quick and straightforward birth with that baby and so I was prepared that this labour could be quick again.

The pregnancy progressed without any concerns and at term she called me to ask me to attend … she didn’t feel she was actually in labour, but in view of the fact that she lived some distance from me, she felt she may need me to be there to go into labour.

On arrival with my client I performed the usual checks, blood pressure, urinalysis and abdominal palpation.  Hmmmm … felt strange … I asked if I could perform a vaginal examination (something that I rarely need to do) and sure enough there was no head presenting.  Indeed to start with I wasn’t sure what was presenting – perhaps a leg, perhaps an arm … but her cervix was very dilated, so she had been quietly labouring overnight!

We discussed her options, and I consulted with other colleagues for suggestions and asked another midwife to attend.  Obviously this was not going to be a usual scenario and we discussed transfer to hospital.  My client felt that neither she nor baby were in immediate danger so she preferred to stay at home and try a “knee-chest” position to attempt to move the baby.  This was actually quite successful, and a further vaginal examination showed that the leg/arm had moved.  I still wasn’t sure what I was feeling, and mother and baby were well so we continued.

On a further examination I determined that it was definitely a little leg and foot presenting, so at least we now knew what we were dealing with!  My client felt very trusting that all would be well, or at least accepting of whatever happened.  Her labour was slow and not at all usual, but, it was similar to her two previous labours and we were reassured by this.

Slowly, slowly things progressed and eventually we saw a little foot presenting!  I have some experience of breech birth (as did my second midwife) and I felt quite confident in both my ability and the mother’s.  The foot became a leg, one leg became two legs, little boys “bits” showed, the torso emerged, then one arm and another, before finally a head was born with the membranes stuck tight!  The baby was in good condition and needed no help (something we were all expecting, as breech babies are much more likely to need some resuscitation).

Wow, what a great day – mother was so very pleased with herself, and Dad too – he was great!  Midwives hugged and baby was cuddled!

So, breech babies can be born normally.  Of course it is always going to be slightly more risky and some breech babies will need to be born by caesarean, but this woman would almost certainly have had a caesarean if she had gone to hospital and here she was tucked up in bed with her family at home.

Oh, and by the way, he weighed 9lb!

In recent years most breech babies have been born by caesarean section in the UK.  Doctors usually suggest that a caesarean is the preferred option, however some midwives and doctors do not necessarily agree and certainly some mothers prefer to attempt a vaginal birth.

There is an excellent resource written by Jane Evans called “Breech Birth – What are my options?” available from www.aims.org.uk which talks about all the options.

If you should find your baby in the breech position there are several things you can try in an attempt to turn the baby cephalic (or head down).

First of all you could ask your doctor about External Cephalic Version (ECV) when a doctor attempts to manually turn the baby (from the outside).  This is done under very carefully controlled conditions; usually on labour ward just in case the baby becomes distressed and a caesarean is needed.  ECV can be quite uncomfortable and even painful but does have a reasonable success rate.

I always think it is worth considering alternatives, be that acupuncture, homoeopathy or chiropractic.  After all you have nothing to lose and they may well be successful.

Another suggestion is to lie at an angle, either on pillows or ironing board, with your head down and feet up and help the baby to turn over this way.  The theory is that this angle helps the baby tuck their head, thus making it easier for them to flip over, like doing a somersault.  It is recommended doing this fifteen to twenty minutes two to three times a day as early as 32 weeks and until the baby turns head down.   At the same time try to relax and visualise the baby moving into a head down position – even try to communicate with the baby and “tell” him/her to go head down if they can.

Another version of this would be to try few somersaults in the swimming pool (if you can manage it!).

Massage, either used alone or in combination with other ideas mentioned here, such as the “breech tilt” may be helpful.  Simply rub both hands wide and flat around the belly in the direction you want the baby to turn.  Both hands should stay opposite each other and move circularly, around the baby.

A slightly more drastic option is to place an ice pack (do not place directly on your skin) or even a frozen bag of peas against the top of your uterus may cause your baby to attempt to turn it’s head away from the cold temperature, or some people talk about shining a torch on their abdomen to direct the baby to the bottom of the uterus – weird and wacky, but worth a try … you’ve not got anything to lose!

If you want to speak to a midwife about any of these ideas you can always contact me info@3shiresmidwife.co.uk

Yesterday I was asked to speak at the Hinchingbrooke Maternity Services Liaison Committee AGM.  I think it went okay.  The title of my talk was Normal Birth Successes and I spoke about some of the clients I have in my Independent Midwifery Practice www.3shiresmidwife.co.uk (obviously stories are anonymized to protect client confidentiality).

I spoke about five beautiful births, one was a lovely waterbirth of a 10lb plus baby, another was a normal birth when the mother had been so frightened that she was planning an elective caesarean when she booked me.  There was also a story of a woman whose first baby had been born by caesarean, her second had been a forceps delivery and her third son (11lb) was born, at home, at Term + 18 days and a client whose first baby was born at home in the breech position and finally a client expecting her first babies who had twins at home.

I spoke about the benefits of having a known midwife at the birth, women are:

  • more likely to have a normal birth
  • less likely to have a caesarean or forceps delivery
  • have shorter labours
  • need less drugs
  • more likely to breastfeed
  • more likely to be happy with their experience
  • less likely to experience postnatal depression

All outcomes are improved when women have a midwife they know and trust.

I often work with women who are considered to be “high risk”, but these brave women sometimes make the difficult choice to labour at home because they want to be left alone, in an unpressurised environment, to get on with their labour in peace.  We know that oxytocin (the hormone needed for labour) flows better when women are relaxed and feel safe.  Often the journey to hospital, or meeting a new midwife will be enough to stop contractions (if only temporarily).

I am passionate about caseload (or one-to-one) midwifery – I believe every woman deserves to have a midwife she knows with her throughout her pregnancy and birth journey.  I fully appreciate the difficulties this provides for an under-staffed, under-resourced health service – but there are many areas that make this work for a large majority of their clients – why can we not make this a reality for more women?

There are several campaigns to improve things for women (and midwives), please visit  www.independentmidwives.org.uk or www.onemotheronemidwife.org.uk for details.

Heartburn is one of the unpleasant side-effects of being pregnant; it is caused by the hormone, progesterone, which relaxes the valve at the top of your stomach, causing a small amount of stomach acid, sometimes with partially digested food, to surge upwards into your oesophagus (gullet).

Sometimes sickness in early pregnancy can be worsened by heartburn, or indigestion can make you feel sick. If you are expecting more than one baby or your baby is very large this will make your heartburn worse. If your baby is in a breech position in late pregnancy, his head will press up under your diaphragm and may trigger heartburn. Eating certain foods and smoking will also make things worse.

Eating small meals more frequently will prevent your stomach becoming overfull and pushing up under your diaphragm. Try to eat your main meal of the day at lunchtime if at all possible and eat your evening meal early in the evening, so that your body has time to digest it before you go to bed. Avoid spicy, rich, fatty and fried foods and anything else which triggers the symptoms. Sugar, tea, coffee and certain food additives may also exacerbate heartburn. Don’t drink liquids with your food as this causes your digestive juices to become diluted and therefore less effective, but do drink between meals.

Lying down to relax after a meal is likely to cause regurgitation, so it is a good idea to sit upright for a while; you may also find you have to sleep propped up on two or three pillows at night in later pregnancy if the problem gets worse. It may be worth trying complementary therapies such as homoeopathy, aromatherapy or acupressure, or try the following suggestions:

– peppermint, fennel, chamomile or dandelion tea (do not take dandelion tea in large doses or if taking antihypertensives)
– ginger
– milk
– malt drink
– 3 umeboshi plums (health food shop) boil in a pint of water, keep juice in
fridge. Drink as required. Ask for advice.
– Slippery elm “Thompsons” old fashioned stomach soothing drink (health food shop) – Ask for advice.
– Raw garlic or garlic capsules
– Cardamom seeds – chew!
– Cashew nuts – chew well into a paste before swallowing

– extra strong mints

-antacid from the pharmacy (rennies, gaviscon etc) try to avoid taking in large quantities if possible as they can impair your body’s ability to absorb iron

Today I am going to write about my latest project, www.BirthIndex.co.uk

 

BirthIndex.co.uk is an on-line Listings Directory for all things related to Pregnancy, Birth and Baby.  As a Registered Midwife I saw the need to produce this on-line Directory to give clients and families comprehensive information about what is available in their LOCAL area. 

At the moment we have sites up and running in the Bedford, Milton Keynes and Northampton areas but hope to expand this shortly.

The site contains listings relating to pre-conception or fertility advice; pregnancy and birth; postnatal issues; baby equipment; complimentary therapists; childcare and other services for example photographers, activities to do with your baby/toddler.  We are also building a reference library of useful articles and currently have articles on the following subjects:

A Day In The Life Of An Independent Midwife

Alternatives To Hospital Induction

Blood Tests And Scans

Blood Tests For Your Baby

Breech Birth

Foods Rich In Iron

Heartburn Relief

Homebirth List Of Useful Items

Independent Midwives – Endangered Species

Planning A Baby

So You Are Pregnant!

The Big Day!

Top Tips For Labour

Vitamin K

Local events will happily be promoted on the site, and a periodic newsletter will be produced to keep families up-to-date.

I am inviting all related businesses to take a FREE listing on this site.  Additionally there are also other advertising opportunities available at half price for limited period; for example “Enhanced Listings” or “Box” and “Banner” advertisements.

Please do go and have a look around my new site www.birthindex.co.uk  

 

Valerie Gommon

 

 


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