Valerie Gommon Midwife’s Blog

Archive for the ‘Royal College of Midwives’ Category

This is a guest blog by Helen Potter.

There are several reasons why a woman may have a caesarean section. A planned section may be scheduled because of the position or health of the baby, the mother’s medical history or at her request if she has had a previous, traumatic vaginal birth. An emergency section usually occurs because complications have arisen during natural labour. A ceasarean section is a major operation that requires incisions through the abdomen and uterus and so the significant recovery period is well accepted by medical professionals and society in general. However, the emotional after effects of this type of birth remain less acknowledged and far less discussed. The silence and stigma surrounding mental health after a c-section can be detrimental to new mothers who’ve not only just been through major surgery, but now have a newborn baby to care for too. Here are just a few of the emotional issues that may arise following a c-section.

Shock

It’s extremely common for the body to go into shock immediately after the surgery is carried out. Many women report shaking from head to toe as medication from the epidural and affect the muscles. But further on into the recovery process many women experience delayed shock, especially when the c-section was carried out in emergency circumstances. They spend so long preparing for their labour, writing birth plans and building up expectations so when things don’t go to plan it can be a huge surprise. Using a debriefing service following a c-section can be a good way to come to terms with the experience and understand why it had to happen.

Guilt

A study carried out by Channel Mum found that one in five mothers said that opting for a ceasarean would mean that they’d ‘failed’ and with that sense of failure undoubtedly follows feelings of guilt. Outdated social views can lead to women believing that a drug-free, natural labour is the most honourable way to give birth. Some women even report that having a caesarean has made them to feel like less of a woman and less of a mother. Of course this is untrue and all that really matters in labour is that mother and baby both come through the process safely.

Post natal depression

Although all women who go through childbirth are at risk from postnatal depression, studies show that women who have an emergency caesarean are up to six times more likely to suffer from the condition. The longer recovery period and feelings of guilt, failure and lack of control over their own body are all thought to contribute to this, alongside the hormonal changes that all new mums face. It’ is important to speak to a health visitor or GP if you think you could be suffering from postnatal depression. Self help advice, medication and therapy can all help to alleviate the symptoms.

Trouble bonding

Some women report that they have struggled to bond with their babies following a caesarean section. There are several theories for this. Biologically, research indicates that they miss out on the release of the hormone oxytocin (otherwise known as the love hormone). Immediately after natural childbirth the release of this hormone is higher than ever and missing out it can impair the initial bonding process. In addition to this, skin to skin contact (vital for developing early closeness and bonding) is rarely possible straight after a c-section and in many cases the baby is taken away and checked over while the mother recovers. On a more practical level, the long recovery process can sometimes render a new mum unable to carry out day to day care of the child which can make her feel disengaged from her new baby.

Fear of future pregnancy

Sometimes all of these factors combined, along with the physical pain of a c-section, can make women so fearful of a repeat performance that they choose not to become pregnant again. Of course this can be a devastating choice for a woman who really wants another baby. After a c-section, the probability of a natural birth next time is good – research indicates 60-80% of women can potentially go on to have a vaginal birth after a ceasarean (VBAC). But there are risks and these, alongside the fear of another c-section, can be enough to put some women off for life. If you feel like this but still long to expand your family it is important to talk to your GP or debriefing service to familiarise yourself with all of the facts so that you can make an informed choice.

Citation Section

NHS Choices, Ceasarean section, accessed 25.02.16

Metro, Thousands of women with postnatal depression suffering in silence, accessed 25.02.16

The Royal College of Midwives, What is the purpose of debriefing women in the postnatal period, accessed 25.02.16

The Daily Mail, The women made to feel guilty because they didn’t have a ‘perfect’ drug free birth, accessed 25.02.16

NCBI, Increased risk of postnatal depression after emergency ceasarean section, accessed 25.02.16

Psychguides, Living with postpartum depression, accessed 25.02.16

Mail Online, Women who have ceasarean section ‘less likely to bond,’ accessed 25.02.16

Mayoclinic, Vaginal birth after c-section (VBAC), accessed 25.02.16

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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

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.

http://www.timesonline.co.uk/tol/life_and_style/health/article6932530.ece

Men who panic when their partners go into labour may be rushing them into hospital too early. Professor Mary Nolan, of the University of Worcester, said that their interference could be overriding the advice from midwives and leading to greater numbers of complicated births.

Labour can last 12 to 18 hours for a woman giving birth for the first time, and the longer women are in hospital the more likely they are to receive medical interventions such as painkillers or drugs to hasten labour when they don’t need them.

Midwives try to encourage women to stay at home as long as possible because evidence suggests that the longer a woman stays out of hospital, the more straightforward her labour. Hospitals also want to avoid women blocking beds for hours before they give birth.

But a survey of 2,400 women visiting the parenting website Babycentre.co.uk and follow-up phone interviews with new mothers found that despite the advice of midwives to stay at home during the early stages of labour, many fathers had been anxious to get to hospital quickly.

Professor Mary Nolan, from the University of Worcester, said: “Women rely on their partners to support them during labour but many first-time fathers feel that they should get their partner into hospital as quickly as possible.

“Although women are prepared to heed the advice to stay calm and remain at home until they really feel like their labour is progressing fast, the fretting of their partners drove them to go in earlier than they would otherwise have done”.

The findings come as the role of fathers before and during childbirth will be debated at the Royal College of Midwives’ Annual Conference in Manchester today.

Michel Odent, a leading French obstetrician and author, will argue that men should not be present in the delivery room when women give birth, as their anxiety can be catching and make labour longer, more painful or likely to result in a Caesarean section. Men now attend more than 90 per cent of births in the UK, a proportion that has grown significantly since the 1950s.

Dr Odent believes that the birth process had become too “masculinised” in recent years, and delivery of babies would be easier if women were left with only an experienced midwife to help them, as used to be the case.

“It is absolutely normal that men are not relaxed when their partners are giving birth, but their release of adrenaline can be contagious,” he said yesterday. “When a woman releases adrenaline she cannot release oxytocin, the main hormone involved in childbirth, which can make labour longer and more difficult.”

“We have to reconsider the political correctness of the couple giving birth together; it’s not necessarily the best way.”

Duncan Fisher, chief executive of the website Dad.Info, will oppose the motion that “Birth is no place for a father”.

“Of course, not all men are nervous and a lot of women would be even more nervous without their partner there,” he said. “Mothers want them there because it is not home.”

Professor Nolan added that the presence of a caring partner in the labour ward could be valuable to women, especially if shortages of staff meant that no midwives could provide continuous care and support during and after birth.

A poll of 3,500 new mothers for the RCM this week found that one in three were left alone and worried during labour or shortly after giving birth on the NHS.

Andy Burnham, the Health Secretary, said this week that he intends to reform the system of hospital funding to take account of patients’ satisfaction rates, starting with maternity care.

Andrew Lansley, the Shadow Health Secretary is due to announce Conservative policies today which will include “drawing in the whole family around the time of birth” and improving antenatal care. “We often do not involve the father and grandparents as much as they and the mothers would like,” a Tory spokesman said.

Cathy Warwick, the RCM’s General Secretary, commented: “We support a mother’s right to choose her birth partner during labour. There is no evidence base or research, of which we are aware, to suggest that a father’s presence impedes and interferes with the mother’s birth. We will welcome a healthy discussion of these issues during the debate at the conference.”

(Written November 2009)

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.

Understandably, one of the “hot topics” of the moment is should pregnant women accept the Swine Flu vaccine.

On discussions with women I have met with many women who are concerned about the vaccine and unsure whether to be vaccinated

Pregnant women are not known to be more susceptible to catching swine flu but if they do the risk of complications is higher because their immune system is naturally suppressed and the Department of Health is recommending and prioritising the vaccine for pregnant women.  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.  Should a pregnant women develop flu the recommended treatment is early instigation of antiviral therapy.

www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_107768.pdf

Recent Department of Health advice is available at: www.dh.gov.uk/en/Publichealth/Flu/Swineflu/DH_107340

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.

However a recent Guardian article quoted a survey, published by the website mumsnet.com, confirmed the uncertainty felt as almost half – 48% – of pregnant women who responded said they probably or definitely would not have the jab if it is available. Only 6% said they definitely would and 22% said they probably would.

http://www.guardian.co.uk/world/2009/sep/02/swine-flu-vaccine-pregnant-women

Another recent article www.examiner.com/x-4079-SF-Sexual-Health-Examiner~y2009m10d23-California-suspends-ban-on-thimerosal-containing-H1N1-vaccine-for-pregnant-women  also raises concerns about the immunisation programme.

I am unsure which vaccine is being given to pregnant women in the UK – this may be something for you to research further.

Good luck with your decision making.

When a mum is breastfeeding she is giving her baby the very best – breastmilk is full of antibodies and is therefore hugely protective.

The Department of Health has issued advice on what to do when breastfeeding if you have contracted the flu.  If a mum is receiving antiviral treatment or prophylaxis, they are advised to continue to breastfeed as frequent as possible and continue to have as much skin to skin contact as possible with the baby.  Ensuring hands are washed as frequent as possible as well as limiting the sharing of toys.

For more information on breastfeeding and swine flu go to www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/DH_099965

The Netmums website has teamed up with the Royal College of Midwives (RCM) to discover your most recent experiences of maternity services so we can work together to instigate improvements.  Please take a few minutes to complete the joint survey so that areas for improvement in maternity services can be targeted. Please answer the questions in relation to your most recent birth. The results of the survey will be presented jointly with the RCM and Netmums at the RCM’s annual conference on November 26-27th in Manchester and featured in the media before the conference.

The survey can be found at www.surveymonkey.com/s.aspx?sm=B6ZD2GutcFLoG8h7MuAMdA_3d_3d


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