Valerie Gommon Midwife’s Blog

Archive for the ‘FSID’ Category

Today I am going to write about the difficult subject of pregnancy and neonatal loss.

On Friday I attended an excellent, but moving study day about the loss of a baby.

Thankfully this is rare, but it is a sad fact that not all babies will make it; our stillbirth rate is 5.5 per 1000 and this figure has remained constant since the early 1990s; this figure includes all babies that die from after the 24th week of pregnancy.

The case of every single baby that dies is confidentially investigated by The Confidential Enquiry into Maternal and Child Health (CEMACH) www.cemach.org.uk

A third of stillbirths occurred when a baby had reached full-term, and deaths are more common when mothers are under 20 or over 40 and for ethnic minority women with babies of black and Asian women being twice as likely to die and more babies are lost to women from poorer socio-economic groups, however, in over 50% of cases, we still do not know why the baby is dies.

Advances in technology mean that neonatal mortality through premature births has fallen to around 3.5% but each one is a personal tragedy.

It is important that women access antenatal care and that adequate time is given to clients.  If you are concerned about ANYTHING speak to your midwife, your doctor or call the labour ward of your local maternity unit.

If you have been affected by the loss of a baby Sands, the Stillbirth and neonatal death charity offer great support www.uk-sands.org

Well, I was on Three Counties Radio www.bbc.co.uk/threecounties/local_radio/ again last night – there was an item in the news about smoking in pregnancy and I was asked to comment.

Apparently, there is a new government campaign targeted to help pregnant women stop smoking.  The advertising campaign, from NHS Smokefree, will highlight how every smoked cigarette restricts essential oxygen to the baby; it will show that a baby’s heart has to beat harder every time a pregnant woman smokes.

According to statistics put out, around one in five pregnant women in England smoke during their pregnancy.  I have to say that I find this figure surprisingly (and alarmingly) high.  It probably doesn’t correlate with my overall clinical experience and certainly not with my Independent Practice (www.3shiresmidwife.co.uk) where almost none of my clients smoke; there is a definite correlation between social class and smoking and I guess I have usually worked in relatively affluent areas.

I think it is easy to be judgemental – people make choices in their lives, and may find smoking a relief to stressful situations, and one should not underestimate the power of addiction.  That said it is obviously harmful to smoke at any time and even more particularly when pregnant.  Women who smoke (or indeed whose partners smoke) are at increased risk or miscarriage, having smaller babies or cot death.  Additionally there are health risks for the child of an increase in coughs and colds, asthma or chest infections, meningitis, glue ear and lung cancer when they are adult.

It is important that you do not bed-share with your baby if you or your partner are smokers as this significant increases the risk of cot death www.babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf, or indeed breathe too closely over a baby if you have recently smoked as you will be exhaling carbon monoxide for up to an hour after your last cigarette!

Interestingly a poll of 224 pregnant women for the campaign revealed 28% would seek help to stop smoking but were worried about being judged – this is something that we as Health Professionals need to be very mindful of – it is not our place to be judgemental, but to give appropriate information and support.  A total of 38% said they sometimes hid their smoking because they were worried about people criticising them, while 39% said they were ashamed to admit their habit to their midwife or healthcare professional.  A wider survey of more than 2,000 adults found 49% were critical of pregnant women who smoked.

The NHS Pregnancy Smoking Helpline number is 0800 1699 169 and more information can be found at http://smokefree.nhs.uk/questions/smoking-and-pregnancy/

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


Whilst writing the blog about baby wearing and slings a couple of days ago my thoughts turned to where the baby sleeps; this too is a subject that stirs strong feelings.  The majority of pregnant couples are now aware that it is recommended by UNICEF and FSID that babies share a room with their parents at least for the first six months, but the issue of whether to bed-share or not may seem less clear and more controversial and definitely has to be a decision of personal preference.

From my experience I would say that most couples start of expecting that their baby will sleep in some kind of crib next to their bed, but in reality after a few unsettled nights many decide that the best way of everyone getting some sleep is for the baby to spend at least part of the night tucked up in bed with parents.  Indeed it is acknowledged that bed-sharing is helpful in establishing and maintaining breastfeeding.  www.babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf

Many couples are initially concerned that they would “forget” that their baby was in bed with them; however video film studies seem to refute this by showing parents moving around their babies in their sleep.  There are however sensible precautions that need to be observed if you are co-sleeping.  The baby needs to be safe and not vulnerable to falling from the bed, you need to be aware of the potential danger from pillows and overheating by slipping below the duvet and it is strongly recommended that you do not bed-share if you have taken alcohol, drugs or are a smoker however by taking sensible precautions it seems that it is probably safe and may even be beneficial to bed-share www.telegraph.co.uk/health/healthnews/3501035/Sharing-a-bed-with-a-baby-does-not-increase-risk-of-cot-death-research-shows.html and www.nd.edu/~jmckenn1/lab/index.html

The document “Reduce the risk of cot death” (FSID and Department of Health) http://www.fsid.org.uk points out that cot death is rare and that if you follow advice such as sleeping your baby on the back, you will be reducing the risk of cot death considerably.

Advice for parents to reduce the risk of cot death:

  • Cut smoking in pregnancy – fathers too! And don’t let anyone smoke in the same room as your baby.
  • Place your baby on the back to sleep (and not on the front or side).
  • Do not let your baby get too hot, and keep your baby’s head uncovered.
  • Place your baby with their feet to the foot of the cot, to prevent them wriggling down under the covers.
  • Never sleep with your baby on a sofa or armchair.
  • The safest place for your baby to sleep is in a crib or cot in a room with you for the first six months.
  • It’s especially dangerous for your baby to sleep in your bed
    if you (or your partner):
    • are a smoker, even if you never smoke in bed or at home
    • have been drinking alcohol
    • take medication or drugs that make you drowsy
    • feel very tired;
    or if your baby:
    • was born before 37 weeks
    • weighed less than 2.5kg or 5½ lbs at birth
    • is less than three months old.
  • Don’t forget, accidents can happen: you might roll over in your sleep and suffocate your baby; or your baby could get caught between the wall and the bed, or could roll out of an adult bed and be injured.
  • Settling your baby to sleep (day and night) with a dummy can reduce the risk of cot death, even if the dummy falls out while your baby is asleep.
  • Breastfeed your baby. Establish breastfeeding before starting to use a dummy.

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