Valerie Gommon Midwife’s Blog

Archive for the ‘La Leche League’ Category

I have recently had a client whose baby had ankyloglossia and needed a tongue-tie division (or frenulotomy), the baby was having some difficulty with breastfeeding, and the mother was experiencing nipple soreness despite good positioning.

Tongue-tie may be hereditary and is a condition where there is a short or tight membrane underneath the tongue; it can be hard to diagnose and is easily missed. The skin “tie” can be attached at the tongue tip or further back and as a result the tongue-tip can appear heart-shaped; the tongue movements to lift, move from side to side and protrusion can be restricted and this may affect the way the baby feeds.  A recent study found that of babies having feeding difficulties up to 10% had a tongue-tie.

What should you look for?

You may experience pain on breastfeeding your baby, your nipples may become damaged and you may develop mastitis or find it difficult to establish an adequate milk supply (although all these symptoms can relate to positioning issues too).

The baby may have difficulty feeding and may need to feed frequently and for prolonged periods of time to be satisfied. There may also be weight problems, noisy feeding, dribbling and increased windy behaviour (although again your baby could have these symptoms without tongue tie).

Some babies can feed perfectly well despite having a tongue-tie and adjustments to positioning and attachment may be all that is needed if there are problems with feeding.  It is definitely advisable to seek specialist breastfeeding support such as La Leche League, National Childbirth Trust, Association for Breastfeeding Mothers or Lactation Consultants GB and if the problem continues despite this support then tongue-tie division or frenulotomy is an option. You may be able to get an NHS referral from your local breastfeeding clinic or GP; hospitals providing this treatment are listed on the Baby Friendly website, however there are also private practitioners who will perform this for you and some of them are listed at the end of this article.

Should it be decided that a frenulotomy is necessary, the procedure is very simple and takes a few seconds.  Your baby is swaddled and held gently to keep the head still. The tongue-tie is snipped using sterile, sharp, round ended scissors without the need for an anaesthetic; your baby may feel a small amount of pain but will usually settle quickly and will be able to feed, indeed some babies actually sleep through the procedure!  There is usually very little bleeding and any oozing is controlled by applying pressure to the area with sterile gauze and encouraging feeding as soon as possible.

Good information on tongue tie can be found here on the Lactation Consultants GB website.

www.chilternbreastfeeding.co.uk/tongue_tie_division.html

www.ann-dobson.co.uk

www.mosshealthskills.co.uk/denise-pemberton.htm

www.hampshirehomebirths.co.uk

 

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Q.A client of mine has developed a fever due to clogged milk glands (she gave birth 2 weeks ago). She is finding breast-feeding very painful and is concerned about infections.

A.Is it breast that is sore, not nipple area?  If it is the breast, perhaps a red, hot area it sounds like the beginning of mastitis.  It is very important that the woman ensure that her breast is not restricted by clothing or a tight bra, or by squashing her breast as she feeds.

The most important thing is to KEEP feeding.  If necessary perhaps start a couple of feeds on that breast to try to drain the excess milk (but be mindful that the other breast doesn’t become blocked too).  She may develop a fever and flu like symptoms – this can all be managed by just resting and breastfeeding (if caught early).  I suggest she take to bed, be naked with her baby and just rest and feed.  Paracetamol can be taken, as can homeopathy (refer to homoeopath).

Other suggestions are to go into the bath, placing hot flannels on the sore area and to gently massage the breast towards the nipple area to encourage the milk to flow out.  When out of the bath cold compresses can help to relieve the pain.  Some women use quark or cream cheese in a muslin on their breasts.  Also try not to touch the breast (apart from if expressing/feeding) as this encourages the breasts to make more milk.

If the infection really takes hold I suggest she consult a homoeopath/doctor and antibiotics are usually prescribed (if this happens she can still breastfeed).  I had this myself, got the flu symptoms, but managed to stave off full blown mastitis – so it can be done.

If it is the nipple area it is probably more about the position of the baby – she will need to look at this again, or get help – getting the baby to have a big wide open mouth prior to attaching.  For further information I suggest you look at www.breastfeeding.nhs.uk www.nct.org.uk www.laleche.org.uk or www.abm.me.uk

I am probably not going to be able to do this subject justice in a short blog posting, but the subject was being discussed this afternoon on Radio 4 – “Am I Normal?” presented by Vivienne Parry www.bbc.co.uk/radio4/science/.

The programme debated many interesting issues, for example the increase in the diagnosis of postnatal depression and the changing role of women in society.

I apologise that the information below is perhaps written in a slightly “academic” or technical style as it is taken from an essay I submitted on my degree programme, however I think the information is largely valuable – if you feel you would like to discuss anything I have written do feel free to contact me info@3shiresmidwife.co.uk or telephone 01908 511247.

I also feel very strongly that women are often given inadequate support in the postnatal period.  Indeed many women are reporting receiving only two or three postnatal visits from NHS midwives (and then it is not always a trained midwife who visits) and Health Visiting services are also very stretched.  As an Independent Midwife I am able to offer far more support postnatally and this is something that I believe all women deserve.

If you are struggling DO speak to your midwife, health visitor or GP – make a nuisance of yourself!  Self-help groups and lay groups like the National Childbirth Trust (NCT) www.nct.org.uk, La Leche League (LLL) www.laleche.org.uk Meet A Mum Association (MAMA) www.mama.co.uk and Association for Post Natal Illness (APNI) www.apni.org can all be very supportive.

Postnatal Depression

It can be predicted that the early days, months and even years after childbirth are a time of stress for the woman and her family.  Indeed there are also the major physiological changes from the pregnant state into lactation and the return to the usual non-pregnant state of monthly menstruation cycles.  These changes are normal physiological reactions to the changes undergone by the woman (Stables, 1999), often women as said to experience “baby blues” at this time.  Some women, however, go on to experience stronger reactions that may be described as “postnatal depression” or occasionally “puerperal psychosis” (Sweet, 1997).  A few women will be so traumatised by their experience that they develop “post traumatic stress disorder”.

Baby blues” is considered by many to be a normal phenomenon that happens around three or four days postpartum, and is associated with the rapid physiological and psychological changes taking place.  Many women experience a degree of transient emotional lability and changes or mood that is self-limiting and usually resolves quickly.  (Ball, 1996).

Postnatal depression (PND) is more severe.  Cox, 1986 suggests that 10% of all mothers develop clinical depression following childbirth and that a further 10% exhibit considerable emotional distress.  The onset is gradual and may last for 3-6 months (or longer).  PND is a reactive illness and can be associated with other stress factors (i.e. moving house, marital tension and low self-esteem).  Women suffering PND are usually able to sleep, but continue to feel tired and exhausted, often feeling worse as the day progresses.  PND can cause disruption to family life, and can affect mother-child relationships.  (Ball, 1996).

In recent years Health Visitors have been encouraged to use the Edinburgh Postnatal Depression Scale (developed by Cox et al, 1987) as a tool to detect postnatal depression.  Some authors have suggested that midwives should use the Edinburgh Postnatal Depression Scale (EPDS), (Sweet, 1997 and Clements, 1995) but the tool is not foolproof.   Postnatal women are asked to identify and report on their feelings and they may choose not to disclose feelings.  Feedback suggests that the scale is a useful tool, and can enable further discussion to ensue.  If indicated, the woman may then be offered “listening visits” when the Health Visitor will set aside time to talk on a one-to-one basis with the woman.  Some women may also be helped by medication and the Health Visitor will liaise with the General Practitioner and indeed the wider mental health team if it is thought appropriate.  It is thought that early treatment is most effective, midwives and health visitors should therefore be alert for early symptoms such as excessive anxiety and depression.  (Church and Scanlan, 2002, Bryant et al, 1999).

There has, however, been criticism of The Edinburgh Postnatal Depression Scale.  Robinson, 1998, suggests that it is ineffective because of indiscriminate usage, whilst Ballard et al, 1995 suggest that women often score highly on the EPDS and receive inappropriate treatment.

Puerperal psychosis is a severe form of mental illness that will affect approximately one or two mothers in 1000.  The onset is rapid and usually occurs within the first few days after delivery.  The condition presents as a depressive psychosis, manic illness and in some cases schizophrenia.  Primiparae are most often affected.  Women affected in this way need prompt admission to a psychiatric unit.  (Ball, 1996).

Women can experience Post Traumatic Stress following childbirth, this phenomenon has only been documented in the literature in recent years.  Indeed an extensive literature and internet search did not reveal any mention of post traumatic stress following childbirth until 1994 (Ralph and Alexander, 1994).

During the 1990s there were several articles discussing the merits of offering “debriefing” to postnatal women.  (Charles & Curtis, 1994, Jones, 1996, Westley, 1997, Robinson, 1998).  Interest in labour debriefing revealed that some women experience severe adverse reactions to their birth experience and it was suggested that a small number of women may experience post traumatic stress symptoms following childbirth.  The prevalence of post traumatic stress following childbirth has been estimated at between 1.5 per cent (Ayers & Pickering, 2001) and 1.7 per cent (Wijma et al, 1997), although Laing, 2001 argues that this is probably an underestimation of the problem.

I am very happy to offer a birth debrief to women within my catchment area, please see my website www.3shiresmidwife.co.uk for details.

Lastly, I should add that serious Postnatal Depression only affects a small number of women, but it is important that it is spoken about and that you seek help if you need it.

A listing of events that I am hosting or involved with over the next few months, please feel free to pass on these details to anyone appropriate.

I can be contacted on 01908 511247 if you need any further information.

Antenatal Exhibition – FREE entry
Sunday 8th March 2009
2pm – 4.30pm
The Guildhall, Church of Christ the Cornerstone,
300 Saxon Gate West,
Central Milton Keynes, MK9 2ES
info@3shiresmidwife.co.uk

Love Your Body Exhibition – FREE entry
Saturday 21st March 2009
10 am – 4 pm
Midsummer Place,
Central Milton Keynes
www.loveyourbody.me

Milton Keynes Real Nappy Show – FREE entry
Thursday 2nd April 2009
11am onwards
Chrysalis Theatre, Camphill Community,
Japonica Lane, Willen Park South,
Milton Keynes, MK15 9JY
info@3shiresmidwife.co.uk

Wedding Fair – FREE entry
Sunday 5th April 2009
11am – 4 pm
Holiday Inn, London Road,
Newport Pagnell MK16 0JA
info@3shiresmidwife.co.uk

International Week of Midwife – FREE entry
Part of John Lewis Nursery Event
Saturday 9th May 2009
10 am – 4 pm
Nursery Department
John Lewis, Central Milton Keynes
info@3shiresmidwife.co.uk

National Breastfeeding Week – FREE entry
Saturday 16th May 2009
10 am – 4 pm
In store at Boots Baby Department,
Central Milton Keynes
info@3shiresmidwife.co.uk

Love Your Body Exhibition – FREE entry
Saturday 13th June 2009
10 am – 4 pm
Excape, Central Milton Keynes
www.loveyourbody.me

Antenatal Exhibition – FREE entry
Sunday 28th June 2009
2pm – 4.30pm
The Guildhall, Church of Christ the Cornerstone,
300 Saxon Gate West,
Central Milton Keynes, MK9 2ES
info@3shiresmidwife.co.uk

MK Baby and Toddler Show
Sunday 6th September 2009
The Stadium, Denbigh,
Milton Keynes
info@3shiresmidwife.co.uk

Antenatal Exhibition – FREE entry
Sunday 4th October 2009
2pm – 4.30pm
The Guildhall, Church of Christ the Cornerstone,
300 Saxon Gate West,
Central Milton Keynes, MK9 2ES
info@3shiresmidwife.co.uk

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


My first blog, and introduction to me

I am Valerie Gommon, a Registered Midwife and an Independent Midwife and this is my first attempt at blogging.  First of all, a brief introduction to who I am and what I get up to:

I am a midwife in Independent (or Private) Practice and offer full continuity of care throughout the antenatal period, labour and birth and up to one month postnatal. I have four grown up children and live in North Bedfordshire.

My interest in birth spans more than two decades and started with the birth of my first son.  I was keen to learn more about the birth process and gradually learnt more about childbirth and parenting skills and subsequently had my next three children at home.

I became involved in La Leche League (a group which supports and promotes breastfeeding), the National Childbirth Trust, A.I.M.S. (the pressure group Association for Improvements in Maternity Services), and our local Birth Information Group.  Through my involvement in these groups I began to support other women and acted as a birth supporter and in turn began to teach birth preparation classes and sometimes supported these women during childbirth. Eventually my own children were grown enough for me to consider training to become a midwife and I worked within the NHS for a number of years as both a hospital and community midwife.  I am therefore confident in all areas of midwifery practice including homebirth, waterbirth, active birth and vaginal birth after caesarean section; I particularly enjoy parenthood education.

For the majority of women childbirth should be recognised as a normal event, I enjoy supporting women and families at this significant time in their lives.  My aim is for women to be fully informed and active partners in their care.  I believe this will empower women and their partners to obtain the most from this precious experience and can then enable them to move forwards into parenthood in a positive way.

I am an active campaigner for improvements in maternity services and am a member of Milton Keynes Birth Information Group and MK Mums. I also act as guest lecturer and mentor student midwives. Currently I am a local representative of the Association of Radical Midwives, a member of AIMS (Association for Improvements in Maternity Services), a member of IMA (Independent Midwives Association) as well as being a member of the Royal College of Midwives.

By working independently, I can offer the luxury of unhurried appointments in the comfort of a client’s own home allowing plenty of time to prepare for the birth. I like to think I am an experienced, sensitive midwife who works with clients to help obtain the best possible experience at this special time – pregnancy outcomes (types of birth, length of labour, need for pain relief, maternal satisfaction and length of breastfeeding) have been shown to be improved by having a known and trusted midwife – I believe that this is something every woman deserves and will continue to work towards this aim.

I usually work alone, but have the back up of other Independent Midwives if needed.

Please do feel free to give me a call for an informal discussion if you wish to discuss anything I have written.

Tel: 01908 511247
info@3shiresmidwife.co.uk

www.3shiresmidwife.co.uk


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