Valerie Gommon Midwife’s Blog

Archive for the ‘caseload midwifery’ 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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PRESS RELEASE ISSUED 8th December 2011 by IM UK

RESPONSE TO CONTROVERSY OVER
PRIVATE MIDWIFERY PROVIDER:

SOCIAL ENTERPRISE PROVIDES THE ANSWER
IM UK reads with interest the mixed reactions to news of a contract between private midwifery provider One to One (Northwest) Ltd and NHS Wirral.  The service offered is one the NHS can rarely deliver: continuity of care from a midwife the woman knows, through pregnancy, birth and postnatally. However, concerns have been expressed about the impact of profit-driven private providers on the NHS.

“IM UK believes that the answer lies in social enterprise midwifery: continuity of care delivered by an organisation run by midwives and service users for the benefit of the local community,” states Annie Francis of IM UK.

“That is why we are establishing a social enterprise, named Neighbourhood Midwives, to offer local, community based midwifery services.  Care will be free at the point of access for women but provided by a social enterprise, whose values and culture are firmly rooted in a social mission and purpose. We are well down the path and are ready to provide services from April 2012.

“We are keen to be fully integrated into the whole maternity care pathway, ideally through the planned networks currently being discussed. We will be able to offer care to women planning a homebirth but often unable to access this choice because of current shortages of midwives within the NHS.”

Historically, insurance issues have been a barrier for not-for-profit providers.  During recent debates on the Health and Social Care Bill, Baroness Julia Cumberledge emphasised the need for social enterprise organisations such as Neighbourhood Midwives to be able to access insurance via the NHS Litigation Authority (NHSLA). 
For further information contact:
Annie Francis
07977695948
annie.francis@independentmidwives.org.uk

Jill Crawford
07870924857
jill.crawford@independentmidwives.org.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!

STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS

Royal College of Midwives (RCM), National Childbirth Trust (NCT) Independent Midwives UK (IM UK) Association of Radical Midwives (ARM) Association for Improvements in Maternity Services (AIMS) and the Albany Mums Support Group present:

THE ‘RECLAIMING BIRTH’ RALLY SUNDAY, MARCH 7th 2010

Please consider joining us for this important Rally to support mothers and babies.  “Mothers and babies are the foundations of our society, what is more important than getting the foundations right?”

This is a once in a lifetime opportunity – with an election coming up – to send a very loud message, there is a real sense of all the different stakeholders being united in one voice and it could, with hindsight be seen as the turning point for the midwifery profession.

We demand that all women should have a midwife they can get to know, be able to access home birth, a local birth centre, and that there should be independent midwifery available as an option for women to choose.

Meet at 1.00PM in Geraldine Mary Harmsworth Park, Lambeth Road, SE14EQ

We will march to Whitehall to hand in a petition to the Health Minister and letters to the Prime Minister

Master of Ceremonies: Peter Duncan.  Speakers include: Professor Wendy Savage, AIMS Chair Beverley Beech, Albany Midwife Becky Reed, IM UK Board Member Annie Francis, NCT CEO Belinda Phipps, Albany Mums Support Group campaigner Emma Neamish and Duncan Fisher OBE

PLEASE TELL EVERYONE ABOUT THIS IMPORTANT RALLY.

What is the definition of Natural Childbirth?  A hospital might say that a woman whose labour was induced and who had an epidural was a normal birth; others might say that induction, augmentation, analgesia, episiotomies etc do not constitute a normal birth!

A more radical definition of a natural birth might be a labour that starts spontaneously between 37 and 42 weeks gestation, and progresses to a vaginal birth without any intervention or pharmacological drugs.

Natural childbirth has been given a bad press – women choosing natural childbirth have been described as “hippy types” and indeed there has been an item in the press this week about a midwife who suggested that women would do better to avoid epidurals that has caused considerable outrage!

Pregnancy and childbirth are normal life events, not medical condition; a woman’s body is perfectly designed to give birth.

Of course some pregnancies and labours will need medical help – but the vast majority of women will go through their pregnancy and birth without problems and this process works best when interference is kept to a minimum.

For example anything we do to interfere with this natural processes has consequences – if mother and baby are well I am suggesting that we (the medical profession) should not interfere!

One example of this is the huge number of women whose labours are induced – why?  In some areas women are induced at 41 weeks (interestingly in France a normal pregnancy is defined as 41 weeks!).

Induction is not an easy option.  It is usually quite a lengthy process which makes the mother tired.  It is also usually more painful and the mother is therefore more likely to need pain relief, possibly an epidural … the mother is then less mobile … making it harder for the baby to find a way through the pelvis and consequently she is more likely to need the help of a ventouse or forceps, or even a caesarean section.

We all know that although caesareans are very safe in this country, it is still far safer for both mother and baby if the baby is born vaginally.  A caesarean section is major abdominal surgery which will take weeks and months to fully recover from – and the mother will have a demanding baby to care for too!  Babies born by caesarean also have many more problems, and are far more likely to need to receive Special Care.  There are also implications for future pregnancies – so, although fantastic if needed, caesarean sections are far from ideal.  The World Health Organisation recommends a 5 – 10% caesarean section rate, but our rate is approaching 30%, and I believe 90% at The Portland private maternity hospital!

This interference in birth has been called a “cascade of intervention”, because we do a) we have to do b) and because we do c) d) is also necessary this is also described as “iatrogenic” or hospital induced.  Whatever we do has consequences, for example a woman with an epidural will need more careful monitoring, she will need an IV drip and also a catheter – so you can see this spiral effect, because we do this, we have to do that and so on …

I believe there are several factors that lead to this escalation of intervention in childbirth:

Our cultural conditioning, fear, poor health habits and medical intervention in normal birth (perhaps because of fear of litigation) that make birth difficult often requiring more intervention, including surgery.

With good preparation, much intervention can be avoided – women who have a midwife they know and trust are less likely to need analgesia.  With good preparation they should be in optimal health for the birth – complementary therapies they may have experienced acupuncture, homoepathy, osteopathy or any number of helpful treatments during their pregnancy which will help align their body and prepare them for birth.  They may also have practised relaxation or hypnosis techniques all of which can be hugely beneficial.  There is also much a woman can do to help herself: mobilization, relaxation, support, the use of water …

The satisfaction that a woman feels when she has successfully given birth is amazing – it is empowering and is a fantastic start to the parenting journey, and of course breastfeeding is so much easier when you haven’t got a caesarean section wound on your abdomen.

If things didn’t work out this way for you, remember that you did the very best you could at the time.  Some labours do need help and some mothers and babies wouldn’t survive without the help of our medical colleagues.  If this has raised questions or distress for you I am more than happy to speak to you please do feel free to email me info@3shiresmidwife.co.uk

A difficult or traumatic birth experience has long-lasting implications for both the mother and sometimes her child.  We don’t have many babies in our lifetime and it is important to get things as right as we possibly can!

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.


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