Valerie Gommon Midwife’s Blog

Archive for the ‘Royal College of Midwives’ Category

I have just found an interesting article which says that drugs which are often routinely given to women immediately after birth could reduce their chances of breastfeeding.

www.walesonline.co.uk/news/health-news/2009/09/02/life-saving-childbirth-drugs-could-reduce-ability-to-breastfeed-91466-24586076/

The article is so interesting that I will copy it complete below.  My only query regarding the research is to question whether women who choose not to have syntocinon/syntometrine/ergometrine (the drugs routinely used to speed delivery of the placenta, and which many believe help to prevent haemorrhage) may be better informed – perhaps choosing homebirths or waterbirths where the use of these drugs is less frequent – and therefore more likely to breastfeed.

It should also be pointed out that whilst the vast majority of doctors and midwives believe the use of drugs to deliver the placenta to be beneficial there are others who do not believe that they should be used routinely (see Delivering Your Placenta www.aims.org.uk).

“A study of 48,000 new Welsh mothers has suggested the drugs, which can be life-saving, could also be linked to reduced breastfeeding rates.

Researchers from Swansea University believe the drugs, which are used to prevent bleeding after childbirth, may be the reason why so few mums breastfeed, with only 45% continuing within a week of the birth.

The analysis of the records of women who gave birth in South Wales found the use of the blood-clotting and other drugs were associated with a 7% decline in the proportion who started breastfeeding within 48 hours of giving birth.

Researchers believe the drugs may impede a woman’s ability to produce milk and say new mothers may need greater time and support from midwives if they wished to breastfeed their baby.

Dr Sue Jordan of the university’s school of health science, who led the study, said: “Our results highlight the need for further research and clinical trials. What we would like to see is extra help for new mothers trying to establish breastfeeding by making sure to allow enough time for the effect of drugs given in labour to subside.

“Our new findings could contribute to meeting the government targets of reaching that extra 2% of women breastfeeding per year.”

The study is the second link the research team has drawn between breastfeeding rates and drugs given during or after labour. Their previous research confirmed the link between epidurals and reduced breastfeeding rates which prompted revised guidelines for the NHS on the use of the drugs in labour.

Dr Jordan, however, supported the current medical practice regarding the use of the drugs saying: “The potentially life- saving treatments to prevent bleeding after birth must not be compromised on the basis of this study, but further studies are required to establish ways to minimise any effects on breastfeeding rates.”

Of the women involved in the study, who all gave birth between 1989 and 1999, 65.5% of those who did not receive drugs to prevent bleeding after the birth started breastfeeding their baby within 48 hours of giving birth.

This dropped to 59.1% among those given an injection of oxytocin, a hormone that stimulates contractions and plays a natural role in labour, and to 56.4% of women given an additional injection of ergometrine, given to stop bleeding after the birth.

In the study 79% of women received either oxytocin, ergometrine or both, as is routine in the NHS.

“The decline of 6-7% in those being breastfed could lead to up to 50,000 fewer British babies being breastfed every year than might otherwise be possible,” said Dr Jordan.

UK health surveys claim the results of bottle-feeding can lead to obesity and asthma as youngsters are not getting the natural benefits of a mother’s milk. Bottle-feeding has also been linked to an increased number of mothers being affected by breast cancer.

Rosemary Dodds of the National Childbirth Trust said: “Women need more support to start breastfeeding soon after giving birth and this study adds weight to that. A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs.”

Helen Rogers, leader of the Royal College of Midwives in Wales, said: “We welcome studies like this as it shows the important part midwives can play in breastfeeding. Unfortunately, with staffing levels on maternity units, midwives are looking after mums who need more medical care and attention rather than those who have breastfeeding problems and have no other ill effects from the birth.

“Also, mums are now keen to leave hospital, sometimes within six hours of the birth, and as a result they lose the midwife contact and support they may need if they have problems breastfeeding.”

Dr Jordan said the next step in her research was to seek funding for further research and clinical trials to measure the real effect of medications given during labour and the uptake of breastfeeding.”

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.

Student Midwife Emma Rushin from Derbyshire recently won £50,000 by suggesting a new flavour for Walkers crisps!

Emma Rushin suggested that Walker make a new flavour “Builder’s Breakfast” which combines bacon, buttered toast, eggs and tomato sauce!  The prize money will certainly help fund Emma through her studies as a student midwife.

The issue of student hardship has been a real issue in midwifery circles as student midwives studying on the degree programme are not entitled to a bursary despite working long hours within the NHS.  This has been a contentious issue, and one that has been hotly debated and supported by the Royal College of Midwives (RCM) and others.  Student Midwives are expected to work long hours, and work shifts (including night duty) which largely precludes them from taking part-time jobs like other students.

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

Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html


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.

When out and about doing promotional work for my Independent Midwifery Practice www.3shiresmidwife.co.uk I am often asked what is involved to become a midwife.  It is obviously a profession that many women are called to; for some it is just a whim, they have a baby and think that it is such a wonderful job that they might have a go, but for others it becomes a serious intent.

Midwifery is not just about “delivering” or facilitating a birth.  Midwives are often the first person a pregnant woman will see; we give information and support throughout the pregnancy, labour and birth and postnatal period; we help mothers make informed choices about the services and options available.

The role of the midwife is very diverse; we undertake clinical examinations, provides health and parent education and support the family through pregnancy, birth and early parenting.  We also work in partnership with other health and social care services and midwives are responsible for their own individual practice and have a statutory responsibility to keep up to date with current knowledge.

I have had four children, three born at home and I read voraciously and set about informing myself to achieve my homebirths at a time when homebirth was definitely discouraged.  Having successfully achieved (challenging) but wonderful births at home I have to admit that I did become slightly evangelical about birth and homebirth and wanted other women to feel the same empowerment that I felt.

I was fortunate to have a midwife friend and I began teaching birth preparation classes alongside her, eventually teaching myself, never really thinking that I would be a midwife.  To be honest, I thought I knew too much; I didn’t think that I could bear three years of training to teach me something I already knew!

Time moved on, and I decided that I did want to be a midwife.  It was a long process.  I needed to undertake some up-to-date studying as it had been sometimes since my O levels.  I honestly don’t remember now how long it took, but it was certainly several years – I did an A level, I did an aptitude test, I applied, was rejected, waited a year and applied again (may even have been rejected again), the selection process was hard.  I think 250 applicants for 12 places.  They asked me what I thought were really stupid questions, really difficult questions.  I thought they were mad to turn me down; I was committed, knowledgeable and knew that I would make a good midwife!  Eventually I got lucky and gained a place to study.

The course itself was challenging.  A roller-coaster of a ride; highs and lows; lack of self-belief; difficult things to encounter and teachers that I disagreed with – but three years later I did it, I emerged as a brand new midwife and guess what, I did need those three years (and more) to become a midwife!

The process of applying for midwifery training has changed somewhat since I did my training.  Training is now a University Degree course; usually 3 years unless you are already a Registered Nurse and the minimum requirement to train is two A levels, science subjects are preferred. NVQ/SVQ Level 3, the BTEC National Diploma, or equivalent access to higher education programmes run by colleges of further education, are alternatives. Application is through UCAS www.ucas.ac.uk and you will gain a degree and Registered Midwife qualification.

It is important that you carefully check the financial status of being a student midwife.  The situation is under review, but some recent students have been unable to claim any financial support whilst training and have completed their training in considerable debt.  You will also be expected to attend University and work as a Student Midwife in a clinical setting, this will include shift-work and unsocial hours.  There will be many moans and groans along the way, it is not an easy job – it is challenging and exhausting, you will have to deal with staffing shortages and bureaucracy, but it is still the best job in the world!

More information about midwifery training can be found at:

www.nmc-uk.org/aArticle.aspx?ArticleID=2100

www.rcm.org.uk/jobs-and-careers/becoming-a-midwife/


Twitter