Valerie Gommon Midwife’s Blog

Archive for the ‘Tom Brewer’ Category

I’ve just been listening to the latest episode of The Archers where Helen has just had an emergency caesarean section for pre-eclampsia and thought that it would be a useful subject to write about.

I think it is fantastic that the subject has been covered by the radio programme and on the whole they have got it right (wouldn’t expect anything less from The Archers!) but I would like to add a bit more.

Pre-eclampsia is a potentially serious condition of pregnancy that we are still learning about.  For serious pre-eclampsia the only treatment is to deliver the baby (sometimes prematurely), however for most pregnancies the pre-eclampsia can be monitored and the labour may well start normally and spontaneously, or the labour may be induced around your due date and you may well have a normal birth.

Pre-eclampsia is one of the things that your midwife is looking for antenatally and is usually characterised by a collection of symptoms: raised blood pressure, protein in your urine, swelling (oedema), headaches, visual disturbances and upper abdominal (epigastric) pain.

Many women will experience one or more of these symptoms without developing pre-eclampsia, but if you have two or more symptoms or feel concerned you should definitely speak to your midwife urgently.  For example many women will have a headache or some swelling and this is normal during pregnancy – it is usually only when you have several symptoms that pre-eclampsia is suspected and you will then be referred to hospital for further investigations including blood and urine test and monitoring of the baby’s wellbeing.

Women at increased risk of pre-eclampsia include:

  • Those in their first pregnancy
  • Having high blood pressure
  • Having certain blood clotting disorders, diabetes, kidney disease, or an autoimmune disease like lupus
  • Having a close relative (a mother, sister, grandmother, or aunt, for example) who had preeclampsia
  • Being obese (having a body mass index of 30 or more)
  • Carrying two or more babies
  • Being younger than 20 or older than 40

However if you fall into any of these categories you are still more likely NOT to get pre-eclampsia.

There is some evidence (though not mainstream) that pre-eclampsia may be prevented by eating a really healthy diet and by increasing your protein and salt intake.  It may also be beneficial to stop work slightly earlier in your pregnancy and not to overdo things at the end of the pregnancy.

More information on the dietary aspect can be found at https://midwifevalerie.wordpress.com/2009/08/04/dietary-suggestions-for-pregnancy-from-tom-brewer/

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I have recently had a client birth her twin girls at home.  To give birth to twins at home is a rare event; it is obviously slightly more risky that a single birth.  My client carefully considered the risks and benefits of homebirth.  She had previously given birth at home and felt that for her home was the right place.  She knew she would feel safe, relaxed and that her labour could not be “interfered” with (for example many women expecting twins are encouraged to have an epidural and to give birth with the help of doctors in theatre).

Her pregnancy progressed well; an ultrasound scan showed that the twins were dichorionic, diamnionic which gives the best possible prognosis as each baby was in it’s own amniotic sack and had it’s own placenta.  My client chose to have growth scans which showed that her babies appeared to be growing well and equally she declined the option to see an obstetrician as she felt this might be undermining.

We were mindful that a woman with a twin pregnancy needs excellent nutrition to grow two babies, and to maintain her health and wellbeing and my client ensured that she ate well, especially iron rich foods, protein and extra salt (as suggested by Dr Tom Brewer).    As she experienced pelvic discomfort, she saw a chiropractor throughout her pregnancy and found this to be beneficial; she also experienced heartburn as might be expected with a twin pregnancy.

During the pregnancy we made extensive plans about how we expected the birth to progress; what we would do in the event of  problems and who we would have present at the birth.  We planned to aim for the most experienced team we could muster.  In the event we had four midwives – not because we felt we needed four, but because the midwives were keen to attend a twin birth, and my client was very happy to have them present.

On scan at 36 weeks we were surprised and pleased to learn that both babies were cephalic (head down).  Previously the second baby had been in a breech position.

My client laboured at 39+ weeks.  Her labour was fast and the first baby was born in the birth pool within two hours.  There was a bit of a delay but her second daughter was safely born in good condition and although initially tired, she has recovered well and is doing really well.

This was a fabulous outcome – I was blessed with clients who were strong, did their research and knew that they wanted to give birth at home.  They did not want a homebirth at all costs and would have transferred to hospital if I felt that there was a clinical need.

These ideas are not mainstream, but some people believe that by following this advice there may be a protective factor against pre-eclampsia and cholestasis of pregnancy.  The information certainly won’t do you any harm and may in fact do you a lot of good!

Ideally from about 20 weeks:

1) plenty of protein – 5-7 portions a day – it doesn’t matter what sort but should be a complete protein ie pulse and a grain or an animal product

2) complex carbohydrates. ie whole grain bread, rice, pasta, beans and pulses

3) vitamin B – from whole grains and meat products, brewer’s yeast, marmite etc.

4) vitamin C – fresh fruit and vegetables

5) Salt to taste. This means taking as much salt in your diet as you like. (Against the usual advice regarding salt intake).  The salt should be a good mineral or sea salt, this is to support the haemodilution that occurs during pregnancy.

6) plenty of fresh water to drink.

For more information about this do an internet search as there is information “out there”.


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