Valerie Gommon Midwife’s Blog

Archive for the ‘postnatal’ Category

Very sadly it looks fairly certain that Independent Midwifery will end in October 2013.  The Government and Nursing and Midwifery Council have for a long time been recommending that Independent Midwives should have professional indemnity insurance (negligence insurance) despite it not being commercially available in the marketplace i.e. insurers do not provide this insurance for midwives.  You can read more about the current situation here http://www.independentmidwives.org.uk/?node=11615

An E.U. Directive is now due to come into force to implement this change and our current information is that it will be illegal for us to practice without professional indemnity insurance from October 2013.  This means that women will be denied the choice of choosing an Independent Midwife and we will be denied the choice of working independently and will be forced to stop practising or to return into the NHS.

The Independent Midwives UK organisation has been working tirelessly for years to find a solution and it is just possible that an eleventh hour solution will be found but this is now looking unlikely.

A group of midwives have formed an organisation called Neighbourhood Midwives www.neighbourhoodmidwives.org.uk/ and are working towards setting up an employee-owned social enterprise organization, to provide an NHS commissioned caseload midwifery homebirth service, based in the local community.  This may prove to be a workable alternative to Independent Midwifery but at present (if it comes to fruition) the service will only be able to accept “low-risk” women and this is of concern to all of us who have supported women with more complex situations, for example first time mothers, vaginal birth after a previous caesarean, twins, breech birth and women who are not deemed “low risk”.  The aim of Neighbourhood Midwives will be to extend their remit to include more women as soon as possible.

There is already a precedent for this type of care as One to One Midwives in Liverpool www.onetoonemidwives.org have already managed to set up a caseloading midwifery service (similar to independent midwifery in that a woman will care for a caseload of women throughout the whole of the pregnancy, birth and postnatal period) within the NHS.

It is a very sad time for midwifery and for women’s choice, but perhaps good things will come out of it, I certainly hope so.

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.

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/

This is a guest blog, written by Donna Jones – www.dj-counselling.co.uk
Being a parent can be one of the most rewarding things we can do in our lives but it can also be one of the most frustrating and stressful times too. It can feel like there is constant pressure on us with no time to ourselves.

I see many clients who are suffering with parental stress and are struggling to find ways to deal with it. Our children know just the right button to press to get our stress levels soaring!

Some common symptoms of stress can be:

  • Feeling Irritable
  • Tiredness
  • Anxiety
  • Depression
  • Headaches

Some things that have helped some of my clients are:-

  • Try to step back from the situation, take a deep breath and go and make yourself a cup of tea to give yourself some space for a couple of minutes.

 

  • Have a distraction box, this can be great for any ages, fill it with toys, crayons, colouring books, craft stuff or whatever is relevant for their age. It does not have to cost a lot as you can pick up cheap items from many supermarkets. Ask your children to pick something from the box to act as a distraction to keep them busy for five minutes while you have some time to yourself.

 

  • Your thoughts and how you perceive events around you can change your mood and stress levels. You can’t always change the world around you but you can change your reaction to it.

 

  • Try to plan things to look forward to you are important too and need some ‘me’ time to help you to de-stress

 

  • Know your limits, if your expectations of yourself are always sky high you will inevitably spend a great deal of time being disappointed and frustrated. Instead, be realistic in what you can achieve.

 

  • Get Support seeking support from other people can be the key to getting through stressful situations. Ironically, your reaction when under stress can often be to withdraw from those who might offer the most support. Even worse, stressful times can put a strain on the relationships you most depend on.

 

  • Talk to family and friends about how you are feeling. Talking openly about how you feel can be like opening a door, it helps you get back in control and can highlight the choices you have.

 

  • Not taking on too much, accepting offers of help from others are great ways to help reduce your stress levels.

As parents we also need to remind ourselves that we are doing a good job and to recognise that good is good enough and that no one is perfect.

Learn to relax physically

To help reduce your stress levels relaxation is important but being able to relax your body is a skill. A lot of my clients find it hard to relax as they have spent all day racing round after their children, going to work, doing housework and then when it is finally time to sit down their body is still so full of adrenaline they find it near impossible to switch off.

Some good ways to help you relax are:

  • Physical exercise such as go for a walk or join a dance class.
  • Read a book this is a good form of relaxation as it makes you sit down and also acts as a distraction from the stressful days events by making you concentrate on the contents of the book instead.
  • Breathing exercises Try breathing in for five breaths then out for six slowly.
  • Treat yourself to a relaxation tape or listen to some of your favourite music.
  • Or do nothing, sometimes just to sit still with a cup of tea can do wonders J

By Donna Jones

Counselling by Donna

www.dj-counselling.co.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

No two pregnancies are the same, so it is very important that you continue to look after yourself by eating and resting as much as you possibly can.  Remember this time you are also looking after your little one(s) too.  You may feel better or more tired this time around; and certainly having a toddler is hard work.  If your toddler sleeps then you should rest and not rush around doing housework!  If you are exhausted try asking a friend if they would have your toddler for a couple of hours so you can rest.  I can’t stress enough that you need to eat a good diet – ensure that you eat plenty of protein and iron rich foods.

You may notice that you “show” earlier second time around, this is because your tummy muscles have been stretched before and is quite normal.  You may also notice baby movements a little earlier because you know what you are looking for, but don’t worry if you don’t!

Some women say that they are anxious about labour second time around; if you had a difficult labour talk to your midwife about it – ask her what happened and why it happened and what are the chances of it happening again, however second births are usually much easier and shorter.  It is usual to be a bit anxious about labour – most women are, but remember you did it last time and you can do it again!

I think it is definitely worth attending childbirth classes if you can – I had four children and I went to classes each time – it gives you time to concentrate on this pregnancy and this new baby; and a birth plan is a great idea, second time around you are better prepared as you know what to expect, you know what you want and don’t want to happen so put it down into a birth plan and if you need advice speak to your midwife.

Successive reports have called for one-to-one care in labour as all outcomes are improved, for example women are more likely to have a normal birth if they receive one-to-one care.  However, to some women this means having the same midwife from booking, through the antenatal period, labour and birth and until postnatal discharge – this type of care may not be available in your area unless you employ an Independent Midwife www.independentmidwives.org.uk.

Consider having your baby at home, there are so many benefits, women usually have shorter and easier labours and this time you will be better able to read your body and can stay at home if you feel comfortable and relaxed and you won’t have to leave your first child whilst you are in hospital.  Staying upright and active will help with the contractions and also keep the baby in the best possible position for birth, but your body will tell you what you need to do; try to relax and have faith in the birthing process.

Women generally recover quicker second time around, this is partly because labour is usually quicker and easier – and also because being an experienced mother usually helps to establish feeding more quickly.

Unfortunately, the more babies you have, the stronger the after pains usually are – this is because your uterus is having to work harder to contract.  Ask for paracetamol which will help and is perfectly safe to take.

Remember that your other child(ren) will need extra love and reassurance – your new baby is much tougher than you think, try to involve the older sibling(s) in what you are doing and have patience – it is usual for children to regress a bit when they have a new baby in the house.  Accept any help that is offered and consider staying in your pyjamas for a few days – it shows that you are not at full strength.  I think women try too hard to be superwoman, just allow yourself some time to enjoy your new baby – they aren’t babies for long, although it sometimes feels like it when you are in the thick of it!

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


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