Valerie Gommon Midwife’s Blog

Archive for the ‘Government’ Category

The payment of the Health in Pregnancy Grant (HiPG) to all expectant mothers will end in 2011. This is part of the Government’s wider measures to tackle the UK ‘s current financial deficit, announced by the Chancellor in his Budget speech of 22 June 2010.

“The Government believes the payment of a universal HiPG to be a poorly targeted use of limited public funds, and abolishing it will help in its most urgent task of reducing the UK ’s financial deficit in a fair way.”

The Health in Pregnancy Grant was introduced in April 2009 and was intended to provide support for the general health and well-being of women in the later stages of pregnancy and to help meet wider costs in the run-up to birth.  It is a one-off payment of £190, payable to all pregnant women after they reach the 25th week of pregnancy.  The Government is proposing to introduce shortly a Bill in Parliament that will end entitlement to HiPG for women who reach the 25th week of their confinement on or after 1 January 2011.

The abolition of HiPG will not affect women who are currently pregnant, nor those who will reach the 25th week of pregnancy before 1 January 2011. They can still qualify for HiPG payments if on reaching the 25th week of pregnancy and before the baby is born, however they must submit a claim within 31 days of their midwives issuing them a certified claim form confirming their expected date of confinement.

Amid huge media attention concerning the Government’s planned cuts to the Child Benefit, The National Childbirth Trust has today issued the following statement.

“NCT appreciates the Government’s need to cut the budget deficit and to explore a range of avenues by which to do so.

We have been concerned however, since the emergency budget, that certain measures impact more negatively on families of young children than other groups.

As a member of the Campaign to End Child Poverty, NCT looks forward to working with Government to ensure that proposed changes to child benefit – to be introduced in 2013 – are as fair as possible on families of young children.

The current proposal could be deemed inequitable in its treatment of single income households, be they headed by a single adult or a couple.

NCT is committed to working with Government to achieve the fairest outcome for families.”

This is a guest blog written by one of my clients, Sarah.

I thought it would be interesting to cover having larger babies at home, having just had one (10lb 6oz) and to have a look at  some common worries.

I was lucky enough to have a great midwife for my last birth who was not in any way phased by the possibility of a large baby, however a flippant remark at a late scan made me worry that maybe we are scared into changing our plans by such remarks unnecessarily.  Happily I did go on to have my baby at home!

Common Concerns:-

The baby may be too big to pass through the pelvis (called cephalopelvic disproportion if you like!) – this is not generally considered to be an emergency situation, and if this situation arises, your labour will fail to progress, at which point you can then transfer to hospital to deliver your baby with medical help.  Therefore its realistic to continue to plan for a homebirth and to try for a homebirth with an open mind that you may have to transfer if needed.

Shoulder Dystocia – this is where the shoulders get stuck after the head is born. This can be fatal for baby but fortunately is extremely rare and is considered to be more likely to occur in a hospital birth as research has shown that induction in cases of suspected large babies has not reduced the incidences of this condition.

There are also positions that a midwife can manoeuver a labouring woman into to help to dislodge the shoulders should this occur.
Is baby actually big? Scans are often  shown to over estimate birth weight. One study found this to be the case in 77% of their diagnosis of a large baby. The estimated weight was only within 500g for 41 of the 86 women studied which is a considerable margin!

A UK  Govt  report (CESDI) into the death of large babies declined to use fetal ultrasound estimates as they felt the evidence of their inaccuracies was well documented and went on to concede that this could lead to unnecessary interventions.

Big baby = more pain – pain is subjective so this is a hard one to reassure.  Different labours can be more painful for numerous reasons (ie. position of baby, birthing position, maternal well being etc), and size may have a bearing on this. The head is the hardest part to birth, therefore a very small baby with a larger than average head may well be more painful than a large baby with an average sized head.

Conclusion:-

It appears that although there may be some reasons where a large baby may present problems, the majority are not a foregone conclusion, and generally not posing an emergency situation, and therefore its arguable that its not a reason to abandon plans for a homebirth.

Different positions can be adopted to aid the birth of a larger baby, and by having a larger baby at home, you are still reducing your chances of having medical interventions.
A larger baby is not a reason on its own to have a hospital birth.

PS From Valerie – women do not usually grow a baby that is too big for them.  Exceptions to this could be if Mum is particularly small and Dad is of generous proportions!  This said many smaller women will still go on to birth big babies!

Homebirth

Posted on: July 17, 2010

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

I have just read that High Wycombe Birth Centre is to close having been open only about seven months.

I feel very sad and angry about the whole fiasco.  We are getting such mixed messages from Central Government.  On the one hand we are to encourage home birth, midwife led care (Birth Centres) and on the other hand consultant led care (hospital) is being centralised into larger and larger regional units.

Wycombe consultant unit was closed at the end of last year and this meant that local “high risk” women needed to go to alternative hospitals – perhaps Stoke Mandeville, in Aylesbury which is quite a drive – perhaps half an hour or more.

Whilst I am definitely in favour of birth units I don’t believe that women with complications should have to travel further, and … guess what … the birth centre is now to be closed.  Where is the choice for women?

Although I am highlighting this one Trust, this is not a unique event – this is being repeated throughout the country – Midwifery Led Units are being closed … for example a beautiful, modern, purpose built unit at Hemel Hempstead … with services being centralised into ever larger units (or conveyor belt systems).

We (midwives and women) must shout loudly to preserve normal birth and make services safer for those needing acute medical services.

www.thisislocallondon.co.uk/news/8259376.Revealed__1_in_5_Wycombe_births_need_ambulance_dash_to_Aylesbury/

After the recent emergency budget the Government has been accused of hampering efforts to employ more midwives after it unveiled a two-year pay freeze for workers in the public sector.  www.nursingtimes.net/nursing-practice-clinical-research/clinical-subjects/midwifery/pay-freeze-could-hit-midwife-efforts-says-rcm/5016301.article

The National Childbirth Trust (NCT) this week expressed concern that parents trying to raise a family will bear the brunt of the cuts – http://bit.ly/cc81Zy.  Cuts planned include:

  • child benefit will be frozen for three years
  • a cut in child tax credit for those on combined income of over £40,000
  • health in pregnancy grant (£190) abolished
  • Sure Start grant restricted to only the first-born child
  • Lone parents to look for work when youngest child goes to school.

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