Valerie Gommon Midwife’s Blog

Archive for the ‘National Childbirth Trust’ Category

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

Swine Flu

Posted on: July 22, 2009

There has been considerable debate about pregnancy and swine flu in the media over the past week.  Pregnant women are more susceptible to catching swine flu and more at risk of complications because their immune system is naturally suppressed, however, the Government stressed most swine flu victims suffered only mild symptoms.

The National Childbirth Trust have been criticised for suggesting that women consider delaying a pregnancy during the current flu outbreak, however the Government say that “It is particularly important that anyone who has existing health problems and is thinking about starting a family should talk to their GP first” – this would be standard, sensible advice whether or not there is a flu outbreak.

The Royal College of Midwives said pregnant women should avoid public transport, unnecessary travel and crowds as well as following standard hygiene advice.

It is important to remember that for the vast majority of people (including pregnant women) that, although unpleasant, influenza is self-limiting and the vast majority of people will make a quick recovery.

Obviously if you are unwell do follow the Government’s advice http://www.direct.gov.uk/en/Swineflu/DG_177831 or contact your doctor or midwife for advice.

Following my recent posting when I mentioned that some women choose unassisted birth as a result of previous trauma, I have recently read that  American actor and talk-show host Rikki Lake has revealed that she was sexually abused as a young child.

Ricki Lake bravely discusses her past in her new book “Your Best Birth”.  Lake discusses her past battles with her weight and body image but goes on to describe the healing that she has experienced through her own birthing experiences, and I have to say that this concurs with my experiences as a midwife – I absolutely believe that a positive birth experience can be healing and empowering for women whether their past trauma was sexual abuse or a traumatic birth experience and am very happy to speak to women about this subject www.3shiresmidwife.co.uk.   It is well recognised by midwives that pregnancy and birth are significant times for women who have experienced sexual abuse – memories may well come to the fore, or a woman may remember events that she had previously buried and forgotten.

The documentary “The Business of Being Born”, www.thebusinessofbeingborn.com, which Lake made with filmmaker Abby Epstein, has touched many people and was championed by both the Independent Midwives Association (IMA) www.independentmidwives.org and the National Childbirth Trust (NCT) www.nct-org.uk and has been shown to packed audiences around this country and abroad.

Help is available for survivors of child sexual abuse from a number of sources including:

www.thesurvivorstrust.org

www.childline.org.uk

www.sheilakitzinger.com

Another reason to consider breastfeeding?

Six baby bottle manufacturers in the US are to remove Bisphenol A (BPA) from their products due to consumer demand.  However, these bottles will continue to be sold in the UK.

BPA is an endocrine disrupting chemical (EDC), which means that it can act like oestrogen in our bodies.  In studies with mice, it has been shown that BPA can cause damage to DNA.  Ana Soto, professor of cell biology at Tufts University medical school in the US told BBC News Online:

“We’ve already found evidence that BPA can damage the mammary, the uterus and the male genital tract in lab animals.

“This research shows it alters reproductive cells both in foetuses and in adult animals.”

The problem with BPA leaching into the contents of the container (BPA is used in water drinking bottles too) occurs when the container is heated or the plastic becomes scratched and old.

Belinda Phipps, chief executive of the National Childbirth Trust www.nctpregnancyandbabycare.com, said: “It’s time the companies in the UK followed suit with what the companies in America and Canada are doing. We shouldn’t have bottles on the market that leach BPA. Parents would like to choose not to have BPA in their babies’ feeds and they don’t find that choice easy right now.”

The current advice for mothers is not to heat milk in the microwave in the baby’s bottle and do not pour in boiling liquid straight into the bottle – let it cool down first.  You can also contact the manufacturer of your baby’s bottle and ask about BPA.  If there is enough pressure from parents in this country, hopefully BPA will be banned here too.

This item was written by Nikki Mattie from www.bestthinkpink.com and www.healthybreastscampaign.co.uk

On the 27th April, Harriet Harmen, Government Minister for Women and Equality published The Equality Bill www.equalities.gov.uk/media/press_releases/equality_bill.aspx which is expected to come into force from Autumn 2010.   The National Childbirth Trust (NCT) the leading parent’s charity and pressure group have welcomed the proposed Bill www.nctpregnancyandbabycare.com/press-office/press-releases/view/52 under which mothers will get the legal right to breastfeed a baby up to the age of six months in any public place (something that is already enshrined in Scottish law).  Under current laws, women who breastfeed in places such as restaurants or busses can be charged under public order or indecency legislation.

The benefits of breastfeeding are well documented (see www.midwifevalerie.wordpress.com/2008/12/31/breastfeeding/) and ministers are changing the law in response to concerns that Britain has the lowest breastfeeding rate in Europe.  National Breastfeeding Awareness Week 10th – 16th May 2009 www.breastfeeding.nhs.uk/en/fe/page.asp?n1=5&n2=13 aims to raise awareness of the benefits of breastfeeding in an attempt to improve our breastfeeding rate and this Bill will surely support breastfeeding women.

As part of National Breastfeeding Awareness Week, I shall be in-store at the Baby Department, Boots the chemist plc, Central Milton Keynes on Saturday 16th May between 10am and 4 pm.  I will be available to answer any questions you may have on pregnancy, birth and early parenting including breastfeeding.  Please do come along and say hello!  More details can be found at www.3shiresmidwife.co.uk


There has been quite a bit of debate this week about whether women should have access to an epidural in labour.

Of course in the majority of cases women do have access to an epidural in labour if this is what they choose, however many maternity units cannot GUARANTEE that a woman will get an epidural when she requests one.  This may be for several reasons.  A woman who has an epidural needs to have one to one midwifery care to ensure the safety of both the mother and her baby.  If a unit is particularly busy or poorly staffed a midwife may not be available to give this level of care (it is well documented that midwives are often caring for two or more women who are in active labour), secondly, an anaesthetist may not be immediately available.

The debate occurred because there have been several articles in the media recently regarding the National Childbirth Trust’s (NCT’s) views on women’s access to epidurals following the publication of a guidance document, “Making Normal Birth a Reality”, drawn up by the NCT with the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. www.appg-maternity.org.uk/resource/Normal+Birth+Consensus+Statement+NEW+LOGO.pdf and www.nct.org.uk/press-office/press-releases/view/128

There was a very interesting debate on Woman’s Hour this week when Belinda Phipps, the Chief Executive of the National Childbirth Trust was interviewed opposite Smriti Singh.  www.bbc.co.uk/radio4/womanshour/02/2009_10_thu.shtml and

The programme highlighted that epidurals are extremely safe (and I say thank goodness for the fantastic medical care we have if it is needed), but I personally do feel that there are very good reasons for avoiding an epidural if possible.

Epidurals are not recommended until a woman is in “established” labour, that is that she is having regular, strong contractions and that her cervix is dilated (usually to 3cm).  The reason for this recommendation is that if the epidural is given earlier the labour could stop as labour may not be fully established.

By having an epidural, a woman is usually confined to bed.  She will need to have her baby continuously monitored by a cardiotocograph machine (CTG) as the epidural can affect the baby, she will also need an intravenous drip because the epidural can significantly lower her blood pressure and she may well also need a urinary catheter to keep her bladder empty.  Being confined to bed will not allow the normal active behaviour of the mother which will help the baby into the optimum position for birth, nor will she have the affect of gravity.  Epidurals occasionally allow the labour to progress more quickly, but more likely the labour will slow and an oxytocic drug (syntocinon) will be needed to increase contractions, and so the “cascade of intervention” continues.  It is also true that women are slightly more likely to need assistance from either a ventouse or forceps to deliver their baby as it is more difficult to “push” out the baby when you have an epidural.

Whilst being an advocate for my clients, and if (given this knowledge) a woman chooses an epidural I honestly believe it is my job to support her in this choice; this said, I believe that far fewer women would actually choose an epidural is they received appropriate one to one support, preferably from a known midwife during their labour.

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.


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