Valerie Gommon Midwife’s Blog

Archive for the ‘NCT’ Category

In a paper published yesterday in the British Medical Journal researchers from the University of London Institute of Child Health (UCL) claim that relying purely on breastfeeding for the first six months might not be best for babies. Interestingly, the study “acknowledges that three or four of the authors have performed consultancy work and/or received research funding from companies manufacturing infant formula” which brings into question the validity of the research; a further criticism is that research needs to be population specific.

Today, many prominent organisations have spoken against this paper, however it is confusing for members of the public and undermines the work that midwives and others do to promote breastfeeding.

The current advice in the United Kingdom based on World Health Organisation guidelines, says that babies should be exclusively breastfed for 6 months however the UCL team say that weaning could happen as early as four months as it is claimed that the later weaning might increase food allergies and lead to nutrient deficiencies.  This statement is heralded as a “retrograde step” by the Royal College of Midwives professional policy adviser Janet Fyle and others.   Indeed a Department of Health spokeswoman said: “Breast milk provides all the nutrients a baby needs up to six months of age and we recommend exclusive breastfeeding for this time. Mothers who wish to introduce solids before six months should always talk to health professionals first.

In summary the current best advice is to exclusively breastfeed for six months and then to continue breastfeeding with food supplements for at least a year.

Further discussion can be found at:
www.guardian.co.uk/lifeandstyle/2011/jan/14/breastfeeding-comment-joanna-moorhead

I guess the first choice is where do you want to give birth, at home, in a birthing centre or in a hospital?  Although you may be asked this at your first appointment you can actually decide at any time, even when you are in labour (although it may be easier if you make plans earlier).

There are so many factors to take into account, but the most important thing is to give birth where you feel safest.  Labour is a very instinctive, hormonal event and if you are scared or unhappy with your environment you will not labour so easily.

Homebirth:

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

Birth Centre/Midwifery Led Unit:

These are often seen as a half-way house between home and hospital.  They have many of the benefits of home, a more relaxed environment but if you are concerned about the privacy aspect of birth (for example if you live in a shared house, or are concerned about the neighbours) or the mess (which in reality is rarely an issue) then a birth centre may be right for you.

Birth Centres are only an option for women whose pregnancy is defined as “low risk” which means that the birth is expected to progress without complication.  Should a complication occur you will need to be transferred into a hospital where more advanced help is available.

Hospital:

Many women choose to give birth in hospital because they believe it to be the safest place.  Of course it is true that the hospital will have advanced facilities if needed however you should also bear in mind that sometimes these facilities are over-used and that just by setting foot in a hospital you increase your chance of using some of that help!  If you choose to give birth in hospital my top tip would be to stay at home as long as possible.

Waterbirth:

I think the use of water in a labour and birth can be hugely beneficial.  I recognise that not all women will want or need a waterbirth, but I would strongly recommend all women not to rule the use of water out.  It may be that you use water by having a bath or shower in labour; it can be hugely comforting to have shower water jetting onto your tummy or back whilst in labour.

As I see it, if we are achy or tense a bath is usually helpful.  It works in just the same way in labour; water is usually relaxing.  Another benefit is that women are much more mobile in labour and have their weight supported by the water making it easier to move around.  Lastly (dare I say it) if you are in a birthpool no one can interfere with you!  You are in your own space and are much more in control of what happens.

Most hospitals now have at least one birthing pool and if it is something that appeals to you I suggest you discuss it with your midwife and let the labour ward midwife know as soon as you arrive at the hospital.  For homebirths there is a considerable choice of birthpools available, for example rigid “bath” type pools that come with and without water heaters and inflatable pools.

Active birth:

Most midwives will agree that by being as active as possible you give yourself the best chance of having a normal birth.  In early labour listen to your body – if you can rest then do so, if you can eat then have something to eat and also make sure you drink plenty and pass urine frequently.  As the labour progresses keep changing position as your body directs; some women want to squat, be on all fours, pace around … most importantly change your position don’t just take to bed.  Being active and gravity will help you baby find its way through your pelvis and may well shorten your labour.

Antenatally it is helpful to prepare for the labour by undertaking gentle exercise, perhaps walking, swimming or yoga.  I wish you a lovely birth wherever you decide it should be!

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

 

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.”

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.

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.

STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS

Royal College of Midwives (RCM), National Childbirth Trust (NCT) Independent Midwives UK (IM UK) Association of Radical Midwives (ARM) Association for Improvements in Maternity Services (AIMS) and the Albany Mums Support Group present:

THE ‘RECLAIMING BIRTH’ RALLY SUNDAY, MARCH 7th 2010

Please consider joining us for this important Rally to support mothers and babies.  “Mothers and babies are the foundations of our society, what is more important than getting the foundations right?”

This is a once in a lifetime opportunity – with an election coming up – to send a very loud message, there is a real sense of all the different stakeholders being united in one voice and it could, with hindsight be seen as the turning point for the midwifery profession.

We demand that all women should have a midwife they can get to know, be able to access home birth, a local birth centre, and that there should be independent midwifery available as an option for women to choose.

Meet at 1.00PM in Geraldine Mary Harmsworth Park, Lambeth Road, SE14EQ

We will march to Whitehall to hand in a petition to the Health Minister and letters to the Prime Minister

Master of Ceremonies: Peter Duncan.  Speakers include: Professor Wendy Savage, AIMS Chair Beverley Beech, Albany Midwife Becky Reed, IM UK Board Member Annie Francis, NCT CEO Belinda Phipps, Albany Mums Support Group campaigner Emma Neamish and Duncan Fisher OBE

PLEASE TELL EVERYONE ABOUT THIS IMPORTANT RALLY.


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