Valerie Gommon Midwife’s Blog

Archive for the ‘DoH’ Category

On the 27th April, Harriet Harmen, Government Minister for Women and Equality published The Equality Bill www.equalities.gov.uk/media/press_releases/equality_bill.aspx which is expected to come into force from Autumn 2010.   The National Childbirth Trust (NCT) the leading parent’s charity and pressure group have welcomed the proposed Bill www.nctpregnancyandbabycare.com/press-office/press-releases/view/52 under which mothers will get the legal right to breastfeed a baby up to the age of six months in any public place (something that is already enshrined in Scottish law).  Under current laws, women who breastfeed in places such as restaurants or busses can be charged under public order or indecency legislation.

The benefits of breastfeeding are well documented (see www.midwifevalerie.wordpress.com/2008/12/31/breastfeeding/) and ministers are changing the law in response to concerns that Britain has the lowest breastfeeding rate in Europe.  National Breastfeeding Awareness Week 10th – 16th May 2009 www.breastfeeding.nhs.uk/en/fe/page.asp?n1=5&n2=13 aims to raise awareness of the benefits of breastfeeding in an attempt to improve our breastfeeding rate and this Bill will surely support breastfeeding women.

As part of National Breastfeeding Awareness Week, I shall be in-store at the Baby Department, Boots the chemist plc, Central Milton Keynes on Saturday 16th May between 10am and 4 pm.  I will be available to answer any questions you may have on pregnancy, birth and early parenting including breastfeeding.  Please do come along and say hello!  More details can be found at www.3shiresmidwife.co.uk

Last week nurse Margaret Haywood was struck of the nurses register by the Nursing and Midwifery Council (NMC) -the professional body for nurses and midwives in the UK.

Between December 2004 and May 2005 Ms Haywood worked as a bank nurse on on Peel and Stewart ward at the Royal Sussex County Hospital in Brighton during this time she kept a diary and undertook secret filming on behalf on the BBC television programme Panorama and a documentary was screened in July 2005.

Ms Haywood, a nurse with 20 years experience, was accused and found guilty of:

(i) Raising concerns about patient care in the BBC Panorama documentary “Under Cover Nurse” when you should have reported the concerns in accordance with Trust policy;

(ii) Breaching patient confidentiality.

The actions of the NMC have caused strong reactions, the union Unite accused the NMC of being ‘heavy handed’ in its treatment of Ms Haywood.

Karen Reay, Unite’s officer for health, said: ‘We can’t have a culture where ‘whistle blowers’ feel intimated into not legitimately reporting wrong doing and bad practice in the NHS. We need a safe environment for ‘whistle blowers’ who feel that they can complain without losing their livelihood.

‘There appears to be a number of extenuating circumstances in the case of Margaret Haywood and the NMC could have imposed a lesser punishment than that of being struck off.’

‘The NMC exists as a regulatory body to protect patients and clients first and foremost, and not the alleged failings of members of the nursing profession in caring for the elderly.’

Ms Haywood admitted breaching patient confidentiality, but said that she had agreed to film undercover inside the Royal Sussex Hospital in Brighton to highlight the awful conditions on the wards.

The programme’s producer Elizabeth Bloor had told the tribunal that “there was an over-arching public interest” in the footage being broadcast.  At the time of the filming the hospital had serious problems with the lowest “star” rating, an £8 million deficit and was receiving complaints about the standards of care given.

After the Panorama programme concerns about standards of care were raised in the House of Commons after the programme and Sussex University Hospitals NHS Trust issued a public apology admitting “serious lapses in the quality of care”.

The actions of the NMC appear to raise questions for NHS staff about how they are able to expose inadequacies in our healthcare system, particularly as Ms Haywood indicated that she had attempted to discuss concerns with her manager with little effect.

www.timesonline.co.uk/tol/life_and_style/health/article6106326.ece

www.nursingtimes.net/nmc-defends-decision-to-strike-off-undercover-nurse-margaret-haywood/5000608.article

I have just learnt that the Royal College of Nursing (RCN) www.rcn.org.uk and an organisation called CAUSE (Campaign Against Unnecessary Suspensions and Exclusions in the NHS (UK)) www.suspension-nhs are fully supporting Ms Haywood stating that a “grave miscarriage of justice” has taken place.  There is also a petition in support of Ms Haywood at www.gopetition.com/online/27030.html

Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html

During your pregnancy you will usually be offered the following blood tests: www.screening.nhs.uk/anpublications/screening_tests.pdf

Full Blood Count – Mainly to test for anaemia

Blood Group – In case you need a blood transfusion
Rhesus group and antibodies – To look for unusual antibodies in your blood/to screen for potential rhesus disease

Rubella antibodies – To check your immunity to rubella (German measles)

Syphilis – To check for syphilis which although very rare could be harmful to you and your baby if untreated

Hepatitis B – An infectious liver disease

H.I.V. – If you are HIV positive treatment can be offered to both you and your baby

Sickle Cell and Thalassaemia – These are genetic blood diseases, usually specific to certain populations (if you feel your ancestors may come from these areas it may be wise to be tested) – we are moving to “universal” testing for these conditions, i.e. that everyone is offered the blood test

* Parts of Africa (the region south of the Sahara Desert)
* Spanish-speaking areas like South America, Cuba, and Central America
* Saudi Arabia
* India
* Mediterranean countries, such as Turkey, Greece, and Italy

Serum screening – This testing performed at around 16 weeks of pregnancy will give a risk factor (high or low) for your baby having Down’s syndrome and neural tube defects (spina bifida). You need to think carefully what you would do with the result. Further investigations such as detailed ultrasound scan or amniocentesis may be offered if you have a high risk result. Amniocentesis gives a definite result but incurs a small risk of causing miscarriage.

You will probably be offered repeat Blood Group and Full Blood Count later in pregnancy.

Ultrasound scans can be performed to:
* date/confirm pregnancy
* Check physical structure of baby
* Nuchal fold – checking for any anomalies in structure of baby
* Assess fetal wellbeing, growth, liquor volume

Many areas are now offering a combined early pregnancy scan and nuchal fold scan – this may be combined with a biochemistry blood test to assess your risk of having a baby affected by Down’s or other Syndromes – in this case the serum screening at 16 weeks in not needed.

It is important to remember that all these tests are OPTIONAL – you can have any, all or none of the above tests after discussing the options with your midwife.

Please do feel free to email me if you have any specific questions: info@3shiresmidwife.co.uk

The Department of Health recommends that all newborn babies be
given a Vitamin K supplement at birth. Approximately 1:10,000
babies may have a rare condition known as haemorrhagic disease
of the newborn, a condition whereby the baby may have
spontaneous internal bleeding. Vitamin K is used in the blood
clotting mechanism.

Vitamin K is available by injection or orally and you should decide
whether or not you wish your baby to receive Vitamin K, and if you
do in what form. The booklet “Vitamin K and the Newborn”
produced by AIMS (www.aims.org.uk) provides a detailed
discussion of the subject.

Babies at higher risk of haemorrhagic disease (Vitamin K
Deficiency Bleeding):

  • premature
  • complicated birth e.g. forceps/ventouse/caesarean section
  • have liver disease that may show as prolonged jaundice or have pale stools or dark urine
  • fail to take or find it hard to absorb feeds
  • are ill for other reasons
  • have bleeding or spontaneous bruising in early infancy

It may be helpful to increase Vitamin K in your diet from 36 weeks.
It is also important that from birth, until a year old if you notice
bleeding or bruising which is unexplained that you get this
investigated as a matter of urgency as it could be an indication of
haemorrhagic disease.

Foods containing Vitamin K include:

Yoghurt, alfalfa, egg yolk, soya oil, fish liver oils, wholegrain
cereals, cauliflower, turnips, green leafy vegetables, broccoli,
cabbage, lettuce, green tea and kelp.

I’ve been thinking for a while that I should write about breastfeeding … I’m sure you are very familiar with the benefits of breastfeeding:

Benefits for the baby
Reduced risk of gastro-enteritis, diarrhoea, urinary tract, chest and ear infections, obesity and diabetes.  Latest evidence suggests reduced risk of Sudden Infant Death Syndrome and childhood leukaemia

Benefits for the mother
Reduced risk of breast cancer, ovarian cancer and osteoporosis (www.babyfriendly.org.uk)

This is apart from the benefits of the convenience of breastfeeding: having an ever-ready continuous supply of breastmilk, no need for sterilization, warming up of milk etc

However despite all the positive work and advances in making breastfeeding more acceptable and normative:

– in November 2004 an Act of the Scottish Parliament made it an offence to prevent or stop a person breastfeeding in a public place www.opsi.gov.uk/legislation/scotland/acts2005/asp_20050001_en_1).

– throughout the UK it is government policy to increase the number of babies who are breastfed (the Government is fully committed to the promotion of breastfeeding, which is accepted as the best form of nutrition for infants to ensure a good start in life. Breastmilk provides all the nutrients a baby needs. Exclusive breastfeeding is recommended for the first six months of an infant’s life www.dh.gov.uk/en/Healthcare/Maternity/Maternalandinfantnutrition/index.htm).

– this is also supported by the World Health Organisation who state Breastfeeding is the ideal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family and the health care system. should be  Exclusive breastfeeding is recommended up to 6 months of age and supplemented breastfeeding up until the age of two or beyond www.who.int/nutrition/topics/exclusive_breastfeeding/en/.

it is therefore disappointing to note that the social networking website Facebook has been removing breastfeeding photographs and and banning users on the grounds that they’d uploaded “obscene content” to their profiles.  In response an on-line protest group “Hey Facebook, breastfeeding is not obscene! Official petition to Facebook” has been launched at www.facebook.com/group.php?gid=2517126532 and a virtual “nurse-in” event was held on 27th December 2008 at www.facebook.com/event.php?eid=39521488436.

Lots of good free information and support about breastfeeding is available:

“From Bump to Breastfeeding” is a great new FREE DVD available to all pregnant women at www.orderline.dh.gov.uk or call 0300 123 1002.

www.breastfeeding.nhs.uk

National Breastfeeding Helpline
Operated by the Association of Breastfeeding Mothers and The Breastfeeding Network
Tel. 0844 20 909 20

La Leche League
Tel. 0845 120 2918

National Childbirth Trust
Tel. 0870 444 8708

The Breastfeeding Network – breastfeeding support in Bengali and Sylhetti
Tel. 07944 879 759



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