Valerie Gommon Midwife’s Blog

Archive for the ‘Health’ Category

I was recently asked a question about painful stitches/perineum after childbirth  and thought it would be useful to share my reply.

I’m not so sure you were told all this! You *should* have been, but sometimes things get missed in the busy hurly burly of hospitals!
Okay, so the pain … I take it this is when you wee? This may well have passed by now? This can be eased by weeing in the bath or shower or by pouring water from a bottle of jug over yourself as you pass urine. The pain gradually lessens but it should already have started to improve. If it is getting worse then you definitely need to get your midwife to check you out.

Don’t know whether you have opened your bowels yet, or if this is what you are referring too? Women are naturally worried about the first time after stitches. I usually suggest that if a woman is anxious that she might like to support the perineum (the stitched area) with some toilet paper when she goes to the loo. This is mostly a psychological prop, but … if it works … it will be fine I promise! Just make sure you drink plenty of fluids (this will also help dilute the urine) and eat so that you don’t get constipated.

Regarding the bleeding, it is normal to bleed for several weeks after having a baby. Again, the bleeding quickly lessens and will often stop only to start again … it is not unusual to bleed on and off for somewhere between 2 – 6 weeks after having a baby.

Your midwife will be very happy to have a look at your stitches and will usually ask you if you are comfortable or not. If you are unsure definitely ask her to look as occasionally they can become infected and need treatment.

Hope you soon feel more comfortable … in the meantime enjoy your new baby.

Another Guest Blog from Sheila Sheppard, Nutritional Therapist.

We know that a baby is nourished in the womb not only by what its mother eats during pregnancy, but also by her body. It’s important, therefore, to be well nourished prior to, throughout and beyond pregnancy to protect your own health.

Here is just one example of how important it is for you to meet your baby’s nutritional needs as well as your own, throughout pregnancy and beyond.

Three weeks after conception, your baby’s brain begins to form, and continues to develop rapidly throughout your pregnancy. The brain is 60% fat and the two most important components are DHA (an omega-3 fatty acid from fish) and ARA (arachidonic acid, from meat, eggs and dairy). These fats are transferred across the placenta and are also present in human milk; they are accumulated in the brain and retina during foetal and infant development.

Most of us consume plenty of foods with ARA so this isn’t usually a worry, unless mum is vegetarian or vegan. Omega-3 is another matter though, as many people don’t eat any fish at all, or avoid oily fish such as salmon, pilchards, sardines, mackerel and tuna.

In her third trimester, the mother needs to eat foods rich in DHA: the placenta takes DHA from her blood and concentrates it in the baby’s circulation; the baby’s DHA level is now double his mother’s.  If she has low blood levels of DHA (because she’s not eating much – or any), DHA is also taken from the richest store – her own brain.  This may account for the slight shrinkage of women’s brain cells and the poor concentration experienced during late pregnancy. The baby continues to need DHA in his milk up to around 4 months and mum needs to keep up a steady intake to protect her own stores of DHA while making sure baby gets enough too.

Research shows that deficiency of omega-3 fatty acids in pregnancy and beyond is linked to post-natal depression, and to behavioural, learning and visual difficulties in children.

Oily fish is recommended 2-3 times per week, and if you can’t manage this then you should seek professional recommendation of a fish oil supplement with good levels of DHA; vegetarian DHA supplements are made from algae. You could also enjoy a regular serving of home made taramasalata (made from fish eggs), a recipe for this is on my website www.nutribaby.co.uk/recipes.php. If you’d like to know more about nutrition in pregnancy, for infants or for weaning, please get in touch.

 

Sheila Sheppard Dip NT, mBANT, CNHC

NutriBaby

Sheila@nutribaby.co.uk

07799 132999

16th April 2012

I am very grateful for this Guest Blog about Hyperemesis Gravidarum or Pregnancy Sickness written by Amanda.  Amanda’s contact details are at the end of the article.

Hyperemesis Gravidarum

So, what is Hyperemesis Gravidarum?

Most people accept that Nausea and Vomiting in Pregnancy (NVP) or “Morning Sickness” is just part and parcel of pregnancy. However very few people are aware of just how bad this can be and that Hyperemesis Gravidarum (HG) even exists.

HG is an extreme form of NVP and is more like having a stomach flu or food poisoning for months on end rather than the occasional moments of nausea and odd vomiting session experienced by most expectant mothers. 

There are many different levels of HG and sufferers range from those who consider it to be “mild”, perhaps battling nausea and vomiting at home right through to those with “severe” HG which has them in and out of hospital throughout their entire pregnancy. Thankfully HG is not the killer that it once could be here in the UK but awareness and compassion from both society and the medical profession is extremely limited. This means that not only does a woman with HG suffer through the worst sickness imaginable, but she does so while having to fight just for the support she needs.

It is often difficult to get a diagnosis and treatment for HG and many doctors are reluctant to prescribe medication until a woman is dehydrated enough to require hospitalisation. And yet many HG survivors who have gone on to have subsequent pregnancies have found that early and aggressive treatment with anti-emetics and IV hydration can limit the severity of their symptoms and make HG much more tolerable, if not necessarily easy.

There are so many symptoms that may suggest a woman has HG, and a whole list of them can be found on the HelpHer website here. However, it is most women’s experience that there has to be a significant loss of body weight and ketones in the urine before their GP or midwife will realise how severe the sickness is.

It is all too common for HG sufferers to be told everything from, “have you tried ginger?” to “this is normal, just get on with it”. A woman suffering from that level of sickness may be too weak to fight for what she needs and often needs an advocate. Yet when facing HG, especially the first time round, it can be all too easy to feel there is nothing you can do and that you just have to accept what the doctor says. In fact it can be far too easy to believe that it really is normal and you are just weak, leading to depression and isolation at how ill you feel and how unable you are to cope with what you believe every other pregnant woman deals with easily.

Which leads to the fact that many HG sufferers not only deal with the physical effects of the condition but can also become very isolated, depressed and even go on to develop Post Traumatic Stress Disorder (PTSD). And the emotional effects of HG can last far beyond the pregnancy itself, even affecting the woman’s decision of whether to face further pregnancies or not. 

Finally, we must not forget the extremely stressful and painful experience that the woman’s partner, parents, siblings and other children go through every single day that she is sick. They can become as isolated and vulnerable as the pregnant woman herself and yet they are so often overlooked even if the woman herself manages to get the treatment she needs.

This is just a very basic overview of what is a complicated and extremely traumatic condition that can ruin what should be one of the most wonderful times in a mother’s life. I cannot possibly do the topic justice on just one page of my blog and so I would like to now draw your attention to some of the most resourceful sites on the web dedicated to this condition before sharing my own personal experience of HG with you and what it has inspired me to work on now my pregnancy is over.

Hyperemesis Gravidarum Resources on the Web

HelpHer – Hyperemesis Education and Research Foundation

The HelpHer website is full of fantastic information for mothers, partners, medical professionals, and the media. It was the most helpful resource I found during my pregnancy and the forums are particularly helpful and supportive both whilst in the midst of HG and afterwards.  

Pregnancy Sickness Support UK

Pregnancy Sickness Support UK is a charity that hopes to offer a support network for HG sufferers and raise awareness of the condition here in the UK. I only found the site after my pregnancy was over but I would sincerely recommend checking it out.

Motherisk

Motherisk is based in Canada and has huge amounts of research available to read online into many different facets of pregnancy that HG sufferers will find interesting, include research into the effectiveness and safety of drugs during pregnancy.

http://amandaclairedesigns.typepad.com/amanda-claire-designs/hperemesis-gravidarum.html

Twitter: @amandaspatch

A guest blog written by Moira D’Arcy, Women’s Health Physiotherapist at St Judes Clinic, Leighton Buzzard.

Protecting Your Back During Pregnancy

During pregnancy changes in your body can affect your back and your posture.  As the weeks pass your weight is no longer centred in the middle of your pelvis but moves forward with the weight of the growing baby.  For most women their posture adapts to compensate for this shift and you may find yourself either slumping forward and flattening out the curve in your low back, or counter balancing the weight by leaning back, at your upper body, which leads to a greater curve and a shift of your weight on to your heels.  The muscles of your back, lower abdomen and your pelvic floor are designed to move and stabilise the joints in your back and pelvis but as your baby grows they are put under more potential strain.  This, along with the adaptations you may make to your changing shape, combined with hormonal (hormones are chemicals that carry messages around your body) changes that loosen the ligaments around the pelvis, can result in low back pain, upper back pain, pubic bone discomfort and general postural strain.

What can you do to reduce those risks?

Stand Tall – imagine that someone is making you feel taller by pulling a string attached at the back and top of your head at the same time as you tightening your tummy muscles and pelvic floor as much as you are able.

Sit Correctly
– make sure your back is well supported. You may prefer a dining chair to a soft chair or sofa.  Placing a small rolled up towel in the hollow of your back may help if you are finding your back is adopting a flattened posture.

Avoid Heavy Lifting
– Your loosened ligaments make them vulnerable so ask for help whenever possible.  If you do have to lift, make sure you hold the object close to your body, and bend your knees rather than your back.  If you are shopping divide your goods into equal loads for each hand.

Wear Comfortable Shoes
– Generally, if you are finding the curve in your low back increasing, flat shoes may be more comfortable as heels will accentuate the curve.

Adapt The Way You Carry Out Your Chores
– eg when vacuuming stand in a walking position, with the Hoover in front of you, then move your feet to the next area and Hoover in front of you again.  Don’t be tempted to push it so far away from your body that you end up bending and twisting your back.

Exercise Regularly
– but unfamiliar routines may damage the joints that loosen during pregnancy so it is wise to seek advice if you are unsure of the suitability of your exercise regime. The most appropriate forms of exercise include swimming, walking, aqua natal classes, Pilates and yoga.  It is important that the instructor is qualified or experienced in teaching pregnant women.  If you are experiencing pelvic girdle pain, or symphysis pubic dysfunction, then always seek advice from a Chartered Physiotherapist prior to beginning any exercise.

You can reduce the risks to your pelvic area and pubic joint by:

 

  1. Standing evenly on both feet.
  2. Sitting on both buttocks and not crossing your legs.
  3. If you have other small children don’t carry them on one hip.
  4. Avoid movements where you are swinging your leg sideways, for example when you get in and out of bed, or a car, turn your hips, pelvis and back in the same direction, while keeping your back straight, so you are moving as a whole and not twisting.

Once your baby is born there is a period of time, while your hormones re-adjust and you resume your usual tasks, when your spine remains susceptible to damage.  This may even be increased by a busy, unfamiliar schedule involving lifting and carrying car seats and prams, combined with feeding postures, picking baby up from their crib and carrying them. It is important to protect your back in the same way you did when you were pregnant.

If you find you cannot resolve your discomfort with this simple advice seek the help of a Chartered Physiotherapist who will be able to identify your specific problems and aggravating activities.  They can then provide you with a tailored programme that will fit in with your schedule.  They can also advise and provide you with supports to relieve/reduce low back pain and pelvic girdle discomfort. 

This information is provided by St Judes Clinic and is intended as general advice during and after pregnancy.  For more detailed advice please book an assessment with us or seek further medical advice from your GP.

Moira D’Arcy  Grad Dip Phys MCSP AACP APPI

Practice Principal

St Judes Clinic

26 Lake Street

Leighton Buzzard

LU7 1RX

Tel: 01525 377751

E-mail: enquiries@stjudesclinic.com

http://www.stjudesclinic.com/health/pregnancy/

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

Where to start?  Every day is different, so I’m going to give you a flavour of the sort of things I get up to.

Of course I have antenatal appointments; from the first tentative telephone enquiry I then arrange to meet up with a potential client (usually for an hour or so) so that we can discuss their past experiences, their hopes for this pregnancy, their concerns and most importantly so that they can get a “feel” as to whether they actually like and trust me.  Once a couple have decided to book me as their midwife I then usually give all their antenatal care in their own home (although I have done antenatal visits in The Bank of England medical room!).  The format of visits is that I carry out all the usual blood tests, urine and blood pressure checks, but also leave a lot of time for discussion so that over the course of the pregnancy we cover issues such as waterbirth, Vitamin K, when to call me and so on.

My clients come from a wide area – I am happy to take clients who live within approximately an hour’s radius of my home in Leighton Buzzard – so I do spend a fair bit of time driving, as well as liaising with G.P.’s and hospitals where necessary.

Four times a year I jointly organise an Antenatal Exhibition, this is an opportunity for pregnant couples to gather information about breastfeeding, pregnancy yoga, cloth nappies and the like.  We also organise Birth Preparation Workshops and am often to be found at the Community Desk in Central Milton Keynes on hand to speak to expectant parents and also regularly attend Study Day’s and midwifery meetings to ensure that I keep myself up-to-date with current research.

Obviously I spend much of my time being “on-call” for births.  My own family are now pretty much grown-up and the commitment isn’t as big as one might imagine as I rarely have more than two births during a month – it is important that I don’t over-commit myself as the whole point of what I do is that I guarantee to be there for the birth.  Babies don’t always read the text books though!  I have had three births in one week, as of course some babies do come early and some come late!  As you will appreciate, the birth is the big event, and it can on occasion go on for some time.

Baby being here doesn’t mean that my job ends!  In fact, postnatal visiting is often one of the busiest times as the family may need quite a lot of support in the early days.  The majority of my clients choose to give birth at home; however some either need to, or choose to give birth in hospital.

I visit my clients for up to four weeks postnatally and it is a joy to see the baby thriving and although discharging clients is always tinged with sadness it is also great to know that I have played a part in helping the family on to the next stage of their life.  (I do usually keep in touch, perhaps not as often as I would like, but I often get e-mails and photographs and usually pop in when I’m passing!).

So, in summary I guess the main differences between me and an NHS midwife are that you are buying my time; antenatal visits usually take around an hour and a half (instead of perhaps 10 – 15 minutes at your local surgery), are arranged more frequently and take place at a time and place to suit you. Most importantly you will receive full continuity of care – I will see you at each visit to build our relationship and plan your care and you will know that (barring exceptional circumstances) I will be with you in labour and available 24/7 for urgent help.

I am always happy to discuss anything that you are concerned about; please do feel free to call.

Written by Valerie Gommon, BA (Hons), RM, Independent Midwife

www.3shiresmidwife.co.uk 01525 385153


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