Valerie Gommon Midwife’s Blog

Archive for the ‘drugs’ Category

http://www.timesonline.co.uk/tol/life_and_style/health/article6932530.ece

Men who panic when their partners go into labour may be rushing them into hospital too early. Professor Mary Nolan, of the University of Worcester, said that their interference could be overriding the advice from midwives and leading to greater numbers of complicated births.

Labour can last 12 to 18 hours for a woman giving birth for the first time, and the longer women are in hospital the more likely they are to receive medical interventions such as painkillers or drugs to hasten labour when they don’t need them.

Midwives try to encourage women to stay at home as long as possible because evidence suggests that the longer a woman stays out of hospital, the more straightforward her labour. Hospitals also want to avoid women blocking beds for hours before they give birth.

But a survey of 2,400 women visiting the parenting website Babycentre.co.uk and follow-up phone interviews with new mothers found that despite the advice of midwives to stay at home during the early stages of labour, many fathers had been anxious to get to hospital quickly.

Professor Mary Nolan, from the University of Worcester, said: “Women rely on their partners to support them during labour but many first-time fathers feel that they should get their partner into hospital as quickly as possible.

“Although women are prepared to heed the advice to stay calm and remain at home until they really feel like their labour is progressing fast, the fretting of their partners drove them to go in earlier than they would otherwise have done”.

The findings come as the role of fathers before and during childbirth will be debated at the Royal College of Midwives’ Annual Conference in Manchester today.

Michel Odent, a leading French obstetrician and author, will argue that men should not be present in the delivery room when women give birth, as their anxiety can be catching and make labour longer, more painful or likely to result in a Caesarean section. Men now attend more than 90 per cent of births in the UK, a proportion that has grown significantly since the 1950s.

Dr Odent believes that the birth process had become too “masculinised” in recent years, and delivery of babies would be easier if women were left with only an experienced midwife to help them, as used to be the case.

“It is absolutely normal that men are not relaxed when their partners are giving birth, but their release of adrenaline can be contagious,” he said yesterday. “When a woman releases adrenaline she cannot release oxytocin, the main hormone involved in childbirth, which can make labour longer and more difficult.”

“We have to reconsider the political correctness of the couple giving birth together; it’s not necessarily the best way.”

Duncan Fisher, chief executive of the website Dad.Info, will oppose the motion that “Birth is no place for a father”.

“Of course, not all men are nervous and a lot of women would be even more nervous without their partner there,” he said. “Mothers want them there because it is not home.”

Professor Nolan added that the presence of a caring partner in the labour ward could be valuable to women, especially if shortages of staff meant that no midwives could provide continuous care and support during and after birth.

A poll of 3,500 new mothers for the RCM this week found that one in three were left alone and worried during labour or shortly after giving birth on the NHS.

Andy Burnham, the Health Secretary, said this week that he intends to reform the system of hospital funding to take account of patients’ satisfaction rates, starting with maternity care.

Andrew Lansley, the Shadow Health Secretary is due to announce Conservative policies today which will include “drawing in the whole family around the time of birth” and improving antenatal care. “We often do not involve the father and grandparents as much as they and the mothers would like,” a Tory spokesman said.

Cathy Warwick, the RCM’s General Secretary, commented: “We support a mother’s right to choose her birth partner during labour. There is no evidence base or research, of which we are aware, to suggest that a father’s presence impedes and interferes with the mother’s birth. We will welcome a healthy discussion of these issues during the debate at the conference.”

(Written November 2009)

Understandably, one of the “hot topics” of the moment is should pregnant women accept the Swine Flu vaccine.

On discussions with women I have met with many women who are concerned about the vaccine and unsure whether to be vaccinated

Pregnant women are not known to be more susceptible to catching swine flu but if they do the risk of complications is higher because their immune system is naturally suppressed and the Department of Health is recommending and prioritising the vaccine for pregnant women.  It is important to remember that for the vast majority of people (including pregnant women) that, although unpleasant, influenza is self-limiting and the vast majority of people will make a quick recovery.  Should a pregnant women develop flu the recommended treatment is early instigation of antiviral therapy.

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_107768.pdf

Recent Department of Health advice is available at: www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_107340

Obviously if you are unwell do follow the Government’s advice http://www.direct.gov.uk/en/Swineflu/DG_177831 or contact your doctor or midwife for advice.

However a recent Guardian article quoted a survey, published by the website mumsnet.com, confirmed the uncertainty felt as almost half – 48% – of pregnant women who responded said they probably or definitely would not have the jab if it is available. Only 6% said they definitely would and 22% said they probably would.

http://www.guardian.co.uk/world/2009/sep/02/swine-flu-vaccine-pregnant-women

Another recent article www.examiner.com/x-4079-SF-Sexual-Health-Examiner~y2009m10d23-California-suspends-ban-on-thimerosal-containing-H1N1-vaccine-for-pregnant-women  also raises concerns about the immunisation programme.

I am unsure which vaccine is being given to pregnant women in the UK – this may be something for you to research further.

Good luck with your decision making.

When a mum is breastfeeding she is giving her baby the very best – breastmilk is full of antibodies and is therefore hugely protective.

The Department of Health has issued advice on what to do when breastfeeding if you have contracted the flu.  If a mum is receiving antiviral treatment or prophylaxis, they are advised to continue to breastfeed as frequent as possible and continue to have as much skin to skin contact as possible with the baby.  Ensuring hands are washed as frequent as possible as well as limiting the sharing of toys.

For more information on breastfeeding and swine flu go to www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/DH_099965

A birth plan is optional – it enables you to devise your own personal plan of care if this is your wish, and can be helpful to health professionals in knowing your thoughts.

It is also an opportunity to make a decision about your care on the basis of informed choice.  By compiling a birth plan, it does not imply that you want a ‘natural’ or ‘alternative’ labour and a birth plan can be changed at any point, it is just an indication of your wishes.

Whether you decide to make a birth plan or not, your care should be discussed with you and no treatment or procedures performed without a full explanation and your consent.

The following are some suggestions of things you might like to include in your birth plan:

Who you want with you for the birth (e.g your partner, a friend or both)

Pain relief (you may be keen to manage without drugs or keen to have as pain free a labour as possible, do you plan a waterbirth)

Positions for labour and birth (you may wish to be able to move around during labour and encouraged to try different positions for the birth)

Monitoring of the baby’s heartbeat (e.g. using a hand-held sonicaid to monitor the baby intermittently or being monitored continuously)

Students (whether you are happy for students to participate in, or witness your birth)

After the birth (do you want pick up the baby yourself/be given the baby or do you want the baby wrapped, do you want to discover the baby’s sex yourself, would your partner (or you) like to cut the cord)

Management of the third stage or placenta (do you want a ‘natural’ third stage or to be given the drug syntometrine

Vitamin K (do you wish your baby to receive Vitamin K either by injection/orally/not at all)

A Birth Plan is just that – a plan, it can be deviated from according to your wishes at the time!

ENTONOX

Also known as “gas and air” (50% oxygen and 50% nitrous oxide).

Self administered through a mask or mouth piece

Used to breathe in and out during contraction

Helps you cope with the pain and also acts as a distraction by giving you something to focus on

ADVANTAGES

Helps take the edge off the pain

Does not affect baby

Can not overdose

Can stop using it at any time

DISADVANTAGES

Can make you nauseous or vomit

Can make you feel “drunk” or out of control

MEPTID

A pain killing drug similar to pethidine.  It is given by injection either into your bottom or thigh.  It usually relaxes you a bit and takes the edge off the pain.  This drug has to be prescribed.  We give an amount proportionate to your weight.

ADVANTAGES

This drug helps some women

The effects on the baby are probably slightly less than pethidine

The nausea/”drunk” feeling may be less than pethidine

Can be given again after 2 hours

DISADVANTAGES

It can make some women feel nauseous and vomit

Some women do not to feel “out of control”

It may affect the baby’s breathing/ability to breastfeed if given shortly before the baby is born

Can not have meptid if having a waterbirth

PETHIDINE

A pain killing drug, given by injection into your bottom or thigh.  It takes about 20 minutes to take effect and lasts for up to four hours.  It usually takes the edge off the pain and relaxes you.

ADVANTAGES

Effective pain relief for some women and relaxing if nervous

Can help you to sleep

DISADVANTAGES

Some women do not like the “out of control” feeling

Can cause nausea and vomiting

For some women it has no effect at all

Pethidine crosses the placenta and can affect baby’s breathing/ability to feed (antidote is available)

Can not have if having a waterbirth

DIAMORPHINE

Similar to Pethidine – A pain killing drug, given by injection into your bottom or thigh.  It takes about 20 minutes to take effect and lasts for up to four hours.  It usually takes the edge off the pain and relaxes you.

ADVANTAGES

Effective pain relief for some women and relaxing if nervous

Can help you to sleep – long lasting

DISADVANTAGES

Some women do not like the “out of control” feeling

Can cause nausea and vomiting

For some women it has no effect at all

Diamorphine crosses the placenta and can affect baby’s breathing/ability to feed

Can not have if having a waterbirth

EPIDURAL

An epidural is where painkilling drugs are passed into the small of your back via a fine tube. It is called a regional anaesthetic, which means the drug is injected around the nerves that carry signals from the part of your body that feels pain when you’re in labour. The result will be that your belly feels numb, giving you very effective pain relief

ADVANTAGES

Good pain relief – especially if labour is long, or instrumental delivery is required

It can be used during a caesarean section and therefore avoids the use of a general anaesthetic

DISADVANTAGES

You need to remain very still whilst epidural is being sited

It causes a drop in maternal blood pressure:

You will need an intravenous drip to counter this drop in blood pressure

Drugs used pass through the placental barrier

Your baby will need to be continually monitored – in extreme circumstances the baby can become distressed necessitating an urgent caesarean section

You will usually need a urinary catheter to empty your bladder

It can slow the labour necessitating a syntocinon drip to get contractions going again

It restricts your movement – usually you will be confined to bed and it can be harder for the baby to get into the best possible position for birth, this can make the labour longer, and make it more likely that you need help (ventouse, forceps or caesarean section)

It may not be 100% effective and you can have “break-through” pain

There is a lack of sensation to ‘push’ in the second stage and this leads to an increased need for ventouse or forceps deliveries

The effects can take some time to wear off



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