Valerie Gommon Midwife’s Blog

Archive for the ‘postnatal’ Category

As an Independent Midwife I have clients within quite a wide geographic area, and it isn’t unusual to have a client who lives up to an hour from my home.  If the client has had several children and previous quick labours I occasionally sleep over at their house when they may be in early labour to ensure that I can get to them in time.  However, although my last client usually had long labours and I was thinking that I’d have plenty of time to get there, but when I saw the snow expected I decided that I should go and camp out with her just in case I couldn’t get to her.  I drove over (in blizzard conditions) and felt very relieved that I had as I wouldn’t have relished the journey in the middle of the night.  In the event, her baby didn’t arrive that night, but she laboured the following afternoon and her baby was born in her sitting room at around 9pm.  It was a fabulous birth, in the pool surrounded by her husband, mother and two children who watched in awe.  We all tucked up in bed afterwards, very content and secure.

The following morning after breakfast I was able to perform a postnatal examination on both mother and baby and had the opportunity to discuss the nights events with my client and her children before setting off to go home.

Fortunately my next clients are much more local to home, but I confess to waking several times in the night recently to look out and check how much snow has fallen – after all a midwife can’t stop working just because there is a little (or a lot) of snow!

From next year the Government has pledged that all women will be offered a choice of where to give birth including at home but so far only half of women are reporting that they were offered a home birth.

A recent survey carried out by www.netmums.com revealed that as many as one-third of all women in NHS hospitals are left alone and worried during, or shortly after childbirth and more than 30 per cent of mums polled received no NHS antenatal classes and 43 per cent did not have access to a midwife on a postnatal ward.

Women who participated in the poll were also very critical of postnatal care, including support offered for breast-feeding, this is despite the fact that the Government is now putting huge investment into improving breastfeeding rates; some women also mentioned that they felt the lack of care had led to postnatal depression.

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM) said maternity services in England are at a critical point; she said that progress was being made. but went on to say that the target to give women a choice of where to give birth looked like it would be missed.  Warwick said surveys suggested full choice was only offered in about 50% of cases.  She also said services were also struggling to cope with the rising birth rate  which has jumped by 20% since 2001.

The RCM say that staffing numbers have increased, but by less than 10%, leaving the health service short of 5,000; they also highlighted that student midwives are finding it difficult to gain employment.

Doulas

Posted on: August 9, 2009

Yesterday someone asked me for my opinion on Doulas, so here goes.

 www.doula.org.uk defines a doula as:

“Doula” (pronounced “doola”) is a Greek word meaning “woman servant or caregiver”. It now refers to an experienced woman who offers emotional and practical support to a woman (or couple) before, during and after childbirth. A doula believes in “mothering the mother” – enabling a woman to have the most satisfying and empowered time that she can during pregnancy, birth and the early days as a new mum. This type of support also helps the whole family to relax and enjoy the experience.

It is tricky to define my feelings about Doulas.  I guess I actually started out as a doula, as I attended the births of several friends in the context of being a birth supporter (although the term doula was not in common usage then). I absolutely feel that the best person to support a labouring woman is another woman who has given birth herself (that said I have met some excellent male midwives … hello Mark and Kevin and I also know some fantastic midwives who haven’t had children themselves). My personal experience with doulas is limited, but has generally been positive – as a midwife I am always happy that a woman is supported by those she feels comfortable with and indeed it can be very helpful to me, however I am also aware that some midwives have had negative experiences of doulas who perhaps have been in conflict with the midwife (and I am sure that some midwives may view doulas less favourably than me).

I find myself slightly uncomfortable with the doulas role partly I guess because I feel that if midwives are doing a good job the midwife would be supporting her client; but also I am concerned that we may be using “untrained” support i.e. doulas or maternity care assistants in place of midwives and this may not be appropriate.  I am increasingly hearing that the role of maternity care assistants (MCAs) is being extended – again, this evokes completely mixed feelings as I know MCAs can be excellent and they should not attempt anything that they have not been trained for, but they are not midwives and have not taken a three year training course.  Are they being used as cheap labour?  Will they miss vital signs and symptoms because of their lack of training?  I don’t know.

There are many positives to employing a doula, for example they will help with domestic duties for example cooking, shopping etc and this may well be beneficial, they are certainly cheaper than hiring an Independent Midwife like myself but their role is different.  For a woman planning a NHS hospital birth where the midwife may well also be caring for other clients it is a way of ensuring that the woman is not left alone and this will be supportive for the woman and her partner.

So I guess my jury is out on this one – I guess it is down to your personal circumstances.

What is the definition of Natural Childbirth?  A hospital might say that a woman whose labour was induced and who had an epidural was a normal birth; others might say that induction, augmentation, analgesia, episiotomies etc do not constitute a normal birth!

A more radical definition of a natural birth might be a labour that starts spontaneously between 37 and 42 weeks gestation, and progresses to a vaginal birth without any intervention or pharmacological drugs.

Natural childbirth has been given a bad press – women choosing natural childbirth have been described as “hippy types” and indeed there has been an item in the press this week about a midwife who suggested that women would do better to avoid epidurals that has caused considerable outrage!

Pregnancy and childbirth are normal life events, not medical condition; a woman’s body is perfectly designed to give birth.

Of course some pregnancies and labours will need medical help – but the vast majority of women will go through their pregnancy and birth without problems and this process works best when interference is kept to a minimum.

For example anything we do to interfere with this natural processes has consequences – if mother and baby are well I am suggesting that we (the medical profession) should not interfere!

One example of this is the huge number of women whose labours are induced – why?  In some areas women are induced at 41 weeks (interestingly in France a normal pregnancy is defined as 41 weeks!).

Induction is not an easy option.  It is usually quite a lengthy process which makes the mother tired.  It is also usually more painful and the mother is therefore more likely to need pain relief, possibly an epidural … the mother is then less mobile … making it harder for the baby to find a way through the pelvis and consequently she is more likely to need the help of a ventouse or forceps, or even a caesarean section.

We all know that although caesareans are very safe in this country, it is still far safer for both mother and baby if the baby is born vaginally.  A caesarean section is major abdominal surgery which will take weeks and months to fully recover from – and the mother will have a demanding baby to care for too!  Babies born by caesarean also have many more problems, and are far more likely to need to receive Special Care.  There are also implications for future pregnancies – so, although fantastic if needed, caesarean sections are far from ideal.  The World Health Organisation recommends a 5 – 10% caesarean section rate, but our rate is approaching 30%, and I believe 90% at The Portland private maternity hospital!

This interference in birth has been called a “cascade of intervention”, because we do a) we have to do b) and because we do c) d) is also necessary this is also described as “iatrogenic” or hospital induced.  Whatever we do has consequences, for example a woman with an epidural will need more careful monitoring, she will need an IV drip and also a catheter – so you can see this spiral effect, because we do this, we have to do that and so on …

I believe there are several factors that lead to this escalation of intervention in childbirth:

Our cultural conditioning, fear, poor health habits and medical intervention in normal birth (perhaps because of fear of litigation) that make birth difficult often requiring more intervention, including surgery.

With good preparation, much intervention can be avoided – women who have a midwife they know and trust are less likely to need analgesia.  With good preparation they should be in optimal health for the birth – complementary therapies they may have experienced acupuncture, homoepathy, osteopathy or any number of helpful treatments during their pregnancy which will help align their body and prepare them for birth.  They may also have practised relaxation or hypnosis techniques all of which can be hugely beneficial.  There is also much a woman can do to help herself: mobilization, relaxation, support, the use of water …

The satisfaction that a woman feels when she has successfully given birth is amazing – it is empowering and is a fantastic start to the parenting journey, and of course breastfeeding is so much easier when you haven’t got a caesarean section wound on your abdomen.

If things didn’t work out this way for you, remember that you did the very best you could at the time.  Some labours do need help and some mothers and babies wouldn’t survive without the help of our medical colleagues.  If this has raised questions or distress for you I am more than happy to speak to you please do feel free to email me info@3shiresmidwife.co.uk

A difficult or traumatic birth experience has long-lasting implications for both the mother and sometimes her child.  We don’t have many babies in our lifetime and it is important to get things as right as we possibly can!

Just a reminder that this group is meeting on Friday 5th June from 12 – 2pm.

An opportunity to discuss any aspect of pregnancy, birth and early parenting, this is a FREE event, and we will be meeting for a shared lunch.

Homebirth – Hospital Birth – Active Birth – Waterbirth – Birth After Previous Caesarean – Breastfeeding – Early Parenting

Do feel free to come along – all welcome.

Phone Valerie on 01908 511247 or email info@mkbig.org.uk for details.         www.mkbig.org.uk

Sincere apologies if any of you came to John Lewis yesterday to meet me for National Breastfeeding Awareness Week.

I am having a busy time!  Attended the birth of a beautiful baby boy yesterday and needed to sleep yesterday.

If you would like to contact me, feel free to email info@3shiresmidwife.co.uk I am always happy to talk informally about any aspect of pregnancy, birth and early parenting.

I am excited to announce that I am planning to revitalise the Milton Keynes Birth Information Group,  and have the first meeting planned for Friday 5th June, from 12 – 2 pm, please contact me by email info@3shiresmidwife.co.uk or telephone 01908 511247 for details.

Independent Midwives from Milton Keynes will be in-store at the Nursery Department, John Lewis, Central Milton Keynes on Saturday 9th May to talk about any aspect of pregnancy, birth and early parenting.  They are aiming to raise awareness of the fact that every minute somewhere in the world a woman dies because of complications in pregnancy and childbirth.  Many of these deaths happen simply because women in many countries lack access to skilled birth attendants such as midwives, or basic medical care.

The event marks the International Day of the Midwife (IDM) on 5th May 2009, when midwives around the world will take action to highlight the knowledge and skills of midwives, and the contribution they make to the health of their nations.  The Royal College of Midwives will be highlighting the United Nations Millennium Development Goal 5 (MDG5), which aims to improve maternal health.

The goal, supported by the UK Government, is to reduce by 75% the number of women who die during pregnancy or childbirth, by 2015.  There are two targets within MDG5; one to reduce maternal deaths and the other to provide universal access to reproductive health.

MDG5 has made the least progress of all the goals since its inception in 2000, but the global voice calling for change is getting stronger.  Maternal Health was on the G8 agenda for the first time ever in 2008 with many governments pledging funding for this issue.  The challenge now is to make sure these pledges are fulfilled.  International Day of the Midwife actions will highlight the need for midwives and celebrate their important role in improving maternal health.

The midwives will also be aiming to raise funds to help mothers and newborns in developing counties, and to help provide skilled midwifery care to women.  IDM is organised by the International Confederation of midwives (ICM), and is supported in the UK by the Royal College of Midwives (RCM) and the White Ribbon Alliance (WRA).

Valerie Gommon from the local branch of the Royal College of Midwives said “Because we have such relatively high quality maternity care in the UK, it is easy to forget the terrible conditions in which hundreds of millions of women have to go through pregnancy and give birth.  We can all do our bit to change this and try to make the horrifying numbers of deaths in pregnancy and childbirth across the world a thing of the past.”

As part of International Week of the Midwife, local Independent Midwives will be in-store at the Nursery Department, John Lewis plc, Central Milton Keynes on Saturday 9th May between 10am and 4 pm.  They will be available to answer any questions on pregnancy, birth and early parenting including breastfeeding.  More details can be found at www.3shiresmidwife.co.uk


Twitter