Valerie Gommon Midwife’s Blog

Archive for the ‘hospital’ Category

I guess this may be more useful if you are planning to hire an Independent Midwife as with the NHS there is less choice, but you still do have a choice of midwife and should remember that if you don’t get on with your midwife you can ask the local Supervisor of Midwives (at the local maternity unit) to help you to find a new midwife.

If looking for an Independent Midwife, I would suggest that you start by looking at www.independentmidwives.org.uk where you can enter your postcode to find the midwives who live closest to you.  This website will then lead you to look at the midwives own websites and you should get a “feel” of the midwives from their websites.  The next step is to email or telephone your favourite midwife(s) to have a chat with them, again this should help you to gauge whether they might be the right midwife for you.

The midwife will want to know where you live (to ensure that she is able to travel to you), she will also want to know when your baby is due (to ensure that she is free at that time) and whether it is your first baby.  If you have had a baby/babies before I would expect her to ask about your experience.  She will also be keen to know where you plan to give birth.

Questions you may like to ask of the midwife include:

How long have you been a midwife? / An Independent Midwife?
Do you like homebirths/waterbirths?
Do you have additional skills (hypnosis training etc)?
What would happen if my baby is breech/I am expecting twins?
What is your normal birth rate?
What is your caesarean rate?
What is your breastfeeding rate?
What is your homebirth rate?
What is your transfer rate?
How much do you charge?
What can I expect from you?
Antenatal care? Labour and birth care? Postnatal care?

I would expect an Independent Midwife to outline the issue of the lack of professional indemnity insurance to you.

If you enjoy speaking to the midwife, I would suggest that the next course of action might be to arrange a consultation.  The midwife will usually be happy to come to your home to meet you and your partner to discuss things in more detail.  Many midwives make a small charge for this meeting to cover their time and petrol costs (this meeting make last a couple of hours) and will be an opportunity for you to ask any questions of the midwife and again to enable you to decide whether she is the right midwife for you.  Most midwives will deduct this fee from the final balance if you decide to book with them.

Some women do “interview” a couple of midwives, and this is perfectly acceptable and perhaps a sensible approach as it will be an important relationship.

An Independent Midwife’s fee may seem expensive, particularly when you can get a similar service for free on the NHS, but I always say to clients that you won’t have many babies and it is important to get things right!  It may be better to employ a midwife and wait a bit longer for the new car or foreign holiday!  An Independent Midwife will usually give you a lot more time than an NHS midwife is able to; she will see you more frequently and give you longer appointments.  The other main benefit is that you will see the same midwife throughout your pregnancy, birth and postnatal period.

I wish you well in your decision-making whether you choose an NHS or Independent Midwife, and if I can be of any help to you please feel free to email info@3shiresmidwife.co.uk

I have recently had a client birth her twin girls at home.  To give birth to twins at home is a rare event; it is obviously slightly more risky that a single birth.  My client carefully considered the risks and benefits of homebirth.  She had previously given birth at home and felt that for her home was the right place.  She knew she would feel safe, relaxed and that her labour could not be “interfered” with (for example many women expecting twins are encouraged to have an epidural and to give birth with the help of doctors in theatre).

Her pregnancy progressed well; an ultrasound scan showed that the twins were dichorionic, diamnionic which gives the best possible prognosis as each baby was in it’s own amniotic sack and had it’s own placenta.  My client chose to have growth scans which showed that her babies appeared to be growing well and equally she declined the option to see an obstetrician as she felt this might be undermining.

We were mindful that a woman with a twin pregnancy needs excellent nutrition to grow two babies, and to maintain her health and wellbeing and my client ensured that she ate well, especially iron rich foods, protein and extra salt (as suggested by Dr Tom Brewer).    As she experienced pelvic discomfort, she saw a chiropractor throughout her pregnancy and found this to be beneficial; she also experienced heartburn as might be expected with a twin pregnancy.

During the pregnancy we made extensive plans about how we expected the birth to progress; what we would do in the event of  problems and who we would have present at the birth.  We planned to aim for the most experienced team we could muster.  In the event we had four midwives – not because we felt we needed four, but because the midwives were keen to attend a twin birth, and my client was very happy to have them present.

On scan at 36 weeks we were surprised and pleased to learn that both babies were cephalic (head down).  Previously the second baby had been in a breech position.

My client laboured at 39+ weeks.  Her labour was fast and the first baby was born in the birth pool within two hours.  There was a bit of a delay but her second daughter was safely born in good condition and although initially tired, she has recovered well and is doing really well.

This was a fabulous outcome – I was blessed with clients who were strong, did their research and knew that they wanted to give birth at home.  They did not want a homebirth at all costs and would have transferred to hospital if I felt that there was a clinical need.

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/

Introduction to Homoeopathy – Ursula Kraus-Harper

Thursday 17th June 8 – 9.30 pm

Talk at NCT event Medbourne Community Sports Pavilion, Pascale Drive, Medbourne

Milton Keynes Antenatal Exhibition

Sunday 20th June,

2-4.30 pm FREE entry,

Christ the Cornerstone Church, CMK opp M&S bit.ly/dBsLmL 300 Saxon Gate West, Central Milton Keynes, MK9 2ES.

FREE entry, refreshment and goody bags. An opportunity for expectant parents to gather information on all aspects of pregnancy, birth and early parenting. Exhibitors include: midwives, breastfeeding, waterbirth, cloth nappies, complementary therapies, ultrasound scan, baby massage, aquanatal and much more!

Please contact me info@3shiresmidwife.co.uk for more details.

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)

The first thing I should say is that Induction of labour is not an easy option and should, in my opinion, be avoided if at all possible.

There are many debates about when women should be induced – the NICE (National Institute of Health and Clinical Excellence) suggest that women should be OFFERED induction at between 41 and 42 weeks of pregnancy www.nice.org.uk/nicemedia/pdf/CG70quickrefguide.pdf

Of course there may be medical reasons for an induction, and these should carefully be discussed with your midwife and doctor, however there are also risks associated with induction, for example you are more likely to have a longer, more painful labour after an induction and you are more likely to need some help for example a ventouse or forceps delivery or a caesarean section.

If it is agreed that an induction is preferable, I would urge you to try “alternative” methods or induction before resorting to a surgical induction https://midwifevalerie.wordpress.com/2008/12/09/alternatives-t…ital-induction/

Although methods of induction vary slightly from area to area, the principles of a “surgical” induction will involve you going into the hospital where you will first be checked over (blood pressure, urinalysis, abdominal palpation), your baby’s heartbeat will then be monitored for a period of time to ensure that the baby is well and that it is safe to proceed with an induction.

You will then be assessed internally to ascertain the best and safest method to induce you.  If it is your first baby and you are not yet in labour it is likely that the doctor will prescribe a drug called “Prostin” which is inserted into your vagina to soften your cervix with the aim of starting labour.  (Prostin is an artificial preparation of the hormone prostaglandin which is naturally present and involved in the labour process.)

Your baby may well be monitored for a period after the insertion of prostin – we want to ensure that s/he suffers no adverse reaction to the drug, – the monitoring is performed by placing two elastic belts around your abdomen to hold a “transducer” (a plastic probe) onto your tummy to obtain a print-out of the baby’s heart pattern (this is just a glorified version of the sonicaid that the midwife uses antenatally to listen to your baby).

Once the midwife is reassured she will be happy for you to get up and perhaps go for a walk or go to the hospital restaurant – it is a good idea to eat as you will need lots of energy when you are in labour!  Some hospitals will also allow you to go home and wait for labour.

Prostin does not always work first time, indeed often women need two, three or sometimes more doses and these are usually repeated at 6 hourly intervals.

An alternative to prostin is to break your waters – this can only be done if your cervix has already started to open – this is more likely if this is not your first baby, or if you have had prostin which has started the process but not put you into labour.

Breaking the waters is not particularly painful, although it can be very uncomfortable.   The midwife or doctor will need to do an internal examination and will attempt to “pop” the bag of waters that your baby is inside.  We use a plastic hook and literally try to burst the balloon of water!

Very often after the waters have broken labour will naturally start within a couple of hours, so again we wait … you can go off for another walk (are you getting a sense of the timescale here … an induction can go on for several days, so don’t expect things to happen in a hurry!).

If at this point the woman still is not in labour we usually suggest giving her a drip with a drug called synotocinon which usually starts uterine contractions.  These contractions are frequently more painful than a natural labour and because we are giving a drug we will also need to continuously monitor the baby’s heartbeat meaning that you are somewhat constrained in your movements (you can still stand by the bed or sit in a chair though).

In a few cases despite all our best efforts none of this will work and we proceed to a caesarean section.

Despite my doom and gloom, many women who are induced successfully labour and go on to have a normal birth, but to give yourself the best chance of a normal birth think carefully about whether an induction is right for you.  The decision as to whether you are induced or not should be made by YOU, in consultation with your doctor and midwife, remember it is your body and your baby, you have the right not to be induced.  A normal pregnancy is defined as between 37 and 42 weeks – so you are not even overdue until you get passed 42 weeks!

More information can be found in “Induction – do I really need it?” available from www.aims.org.uk or as always I am very happy to speak to you info@3shiresmidwife.co.uk

It has been a hard week for Milton Keynes Maternity Unit and for midwifery in general.

Milton Keynes has been severely criticised for staffing shortages which may have led to the death of a baby earlier this year; the Albany Midwifery Practice has been suspended and a midwife hung herself after a baby died.  Tragic.

I trained at Milton Keynes General and I know the staff do a fantastic job under very difficult circumstances – it is obvious that staffing is an issue and this is one of the reasons I left the NHS to work in Independent Practice – I just wanted to be able to give a better standard of care to clients and to give continuity so that women know the midwife who will deliver their baby.  I feel so very sad for the woman and the staff involved.  My only hope is that the service will be better funded as a result, but in the meantime local women will be frightened and this is sad.

Most women will receive safe care in Milton Keynes and from the NHS – the NHS is excellent at delivering acute or emergency care – but what they probably won’t receive is the extra TLC to make the experience special – that is down to the individual midwife and luck depending upon how busy the Unit is.

The excellent Albany Practice in London, which has for many years provided amazing NHS care, has also been closed.  There is a campaign to save it at www.savethealbany.org.uk.

Independent Midwifery is always under threat as the Government insist we must get Professional Indemnity Insurance despite it not being commercially available.  Go to www.kentmidwiferypractice.net to support our campaign.

Midwifery in this country is severely under threat – we must fight to keep midwifery alive!

Sadly a midwife took her own life when a baby she had cared for died.  She mistakenly thought that she was to blame.  How desperately sad that midwives feel so afraid.  We do a difficult job and some babies will die no matter how hard we try to save them.  Midwives, in general, do the job because they care – the vast majority will do their very best for the clients they care for – we need to be supported, not witch hunted and blamed.

I can be contacted at www.3shiresmidwife.co.uk / info@3shiresmidwife.co.uk


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