Valerie Gommon Midwife’s Blog

Archive for the ‘twins’ 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.

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This is a guest blog written by one of my clients, Donna, who has recently given birth to twins.

I’m Donna and I am mother to two year old Grace and 9 week old fraternal twin girls Olivia and Faith.

My husband Paul and I are absolutely thrilled with our new arrivals and that we have two healthy girls.  We are extremely proud parents.  I feel particularly proud that I was able to have them successfully at home and have the birth I wanted.  We always remind ourselves how privileged we are to be blessed with twins as it is one of the hardest jobs either of us have experienced as well as being one of the most rewarding.

Before they arrived I often wondered how we were going to cope with a two year old and newborn twins.  Let me tell you, you just do!  Having said that, as each day goes by, we do find ways to make our lives easier and get into a routine that we are all happy with.

Here are a few of my tips on making day to day life easier with twins:-

1.  Accept that you will need help.  Don’t be proud or try to be super mum.  You will be extremely busy and there is just not enough of you to go around when you have multiples.  I am fortunate that my husband has his own business and works from home so he can help out from time to time however, the majority of men will need to go back to work and that is when you will need to have help.  Call on friends and relatives.  Work out what needs doing and allocate tasks to people.  It may be household chores, getting the shopping (although I do recommend you use online home delivery) or helping with older siblings if you have them. My parents live close by and are great with our two year old plus we have some fantastic friends that we can call upon.  At the end of each day, your house will resemble a jumble sale but my advice is to accept you will be busy and let the less important things go.

2.  If you do have older siblings, we found it beneficial to maintain a routine.  Your first born has always had all the attention from you, friends and family and then suddenly that changes when new babies come into the home.   This is where the help of others really comes in.  So that I could focus on Olivia and Faith, my friends and family focused on Grace.

Before we had the twins, Grace would stay with her grandparents every other weekend.  We have kept this up and she has such a good time.  She has the full attention of my parents and they make a real fuss of her.

When anyone comes to visit, they will always acknowledge Grace first and the twins second.  They would also bring a little gift or card for Grace so as she didn’t feel left out with the twins getting all of the presents. We brought Grace a play house from us and the twins when they were born, she was over the moon with that.

Nursery has been a God send for us.  Grace goes 5 mornings a week and she really enjoys it.  She plays with her friends and again gets all of the attention whilst I spend some alone time with Olivia and Faith.

Paul and I now have to share our time with three children but we make sure that one of us baths Grace every night, cuddles up on the sofa to watch her favourite tv programme and reads her a story before bed.  Paul will also take her to the park most afternoons when work permits.  This was all part of her routine before the twins came along and with some slight adjustments, we have been able to keep it.

We encourage Grace to help out with the twins and play the big sister role.  She fetches me nappies when I need them and helps me to dress them in the morning.  This way, she doesn’t resent them being around.

3.  Plan your week.  To avoid never going out of the house, plan small trips out either to the shops or to visit a friend. Life doesn’t have to end because you have twins.  There are some great support groups you can go to where you can meet other mums of multiples and also take other siblings along. Take up any offers to baby sit so as you can do one thing for yourself.  Mine is swimming.  My mum looks after the twins for a couple of hours in the morning twice a week so as I can go swimming.  It really keeps me sane!

4.  You don’t need to buy two of everything or spend a fortune on items designed for twins.  Things such as moses baskets and cots, they can share.  Co bedding can be very settling for your twins as they have been together for nine months.  Having said that, ours did not like being together in the same moses basket so we did have to get two.  They now share a cot though and are very content and happy and sleep through the night – most of the time.

5.  Your home will be chaos by the end of the day.  I just don’t have the time or energy to do all of the housework.  We decided to get a cleaner who comes once a week for two hours.  I recommend you look for a small independent cleaner rather than an agency.  An agency will tend to start from around £20 an hour whereas an independent cleaner will charge around £8 to £9 per hour.  I know it seems like more expensive but believe me, it will be money worth spending.

6.  Trying to find the time to cook and sit down and eat together is extremely challenging.  I found pre cooking and freezing some simple meals gives you that extra time to eat together when the babies are sleeping.  Just defrost and reheat.

7.  If you are feeding one baby in the middle of the night and the second baby wakes up, I found the use of a dummy beneficial.  I’m not a big fan of dummies but it really helps to keep the other twin calm until you are finished and can move on to feed the next.  I found that most of the time Olivia and Faith don’t want feeding at the same time but it does happen occasionally.

8.  Don’t worry if you can’t always settle your babies.  If they are fed, clean, winded and well, sometimes a baby just has to cry.  They will settle themselves eventually.

9.  Finally, don’t be hard on yourself.  You may want to do everything by the book particularly if you are a first time mum, but with multiples you really need to do what is best for you and your babies.  Just remember if you are content and happy then your babies will be too. An example of this was when my 2 year old Grace had an accident and needed to go to A&E.  Paul took her with a neighbour and I stayed with the twins.  The whole time the twins would not settle until Grace was home and I knew she was ok.  The twins could sense I was anxious and responded to that.

Having twins is such a special thing but nothing and nobody can prepare you for how it will change your life.  For more information on twin or multiple births visit www.tamba.org.uk

Donna has also set up a website which offers information about homebirth; she offers a free ebook at www.happyhomebirth.com

This is a guest blog, written by one of my clients.

My name is Donna and I am a mother of three.  Two year old Grace and nine week old fraternal twin girls Olivia and Faith.

My husband Paul and I had always agreed that we didn’t want a big age gap between our children so when Grace was one year old, we decided to begin trying for baby number two.  I fell pregnant fairly quickly but unfortunately suffered a miscarriage at 5 weeks which was very upsetting.  After a few weeks we were ready to try again and as before, I fell pregnant within a couple of months.

I was very anxious during the first few weeks hoping that this time I would hold onto the baby.  At 12 weeks it was time for the scan.  I was feeling quite relaxed as the pregnancy was going well and I was feeling extremely sick which I thought was a good sign.

The last thing on my mind was the fact that I could be carrying twins.  When the ultrasonographer casually told us ‘oh, you have two in there’, we knew that our lives were going to change forever.  I didn’t know whether to laugh or cry – so I did both!  Everyone in the room was so excited for us but my husband and I were just stunned.  His face was a picture.  They told me that the reason why I had felt so sick was due to the additional hormone racing round my body. They also told us that the twins were fraternal and each had their own placenta and were in their own sac which is the safest type of twin pregnancy.

The first feeling I had once I had calmed down was that of being pregnant for the first time.  My pregnancy suddenly went from having a singleton baby and feeling confident that I had done this before so it will be ok, to all the anxieties of a first time pregnancy.

I knew that I had to do my research so as I could make some informed decisions about my pregnancy and birth.  When I told the ultrasonographer that I was planning a home birth, her reaction was ‘oh, you won’t be able to do that with twins’.  I had a fantastic pregnancy with Grace and had her at home in a birthing pool.  The thought of having to follow a medical route and have my babies in hospital filled me with dread.

As with my first pregnancy, I chose to take on an independent midwife.  This was my preference as I knew I would be less likely to end up with a hospital birth.  I made sure I looked after myself by eating well, getting plenty of rest (as much as Grace would allow me!) and exercised regularly.  I found swimming was great for keeping me fit and taking the weight off my bump.  I had regular scans to check on the twins’ development and position.  Throughout the pregnancy, Olivia (first born) remained head down and Faith was breech.  I knew that this wasn’t ideal but also knew after doing some research that as long as Olivia remained head down and although a little more risky, I could still safely deliver Faith as breech.  At 38 weeks I went for my final scan and to my surprise, Faith had done a full turn and was now head down along with Olivia.  The perfect combination for birth.

We had put together a birth plan that covered every eventuality if I needed to be transferred to hospital at any stage.  Two days after my last scan; my waters broke at 9.30pm when I was lying in bed.  I felt a pop and then a head drop down.  I walked into the bathroom and called downstairs for Paul saying ‘I think my waters have broken!’  He chased upstairs and I told him to call the midwife.  My contractions started almost immediately after my waters broke.  I spoke to my midwife and she told me to go back to bed as things may not start to happen until the morning and I would need my rest.  Olivia was not going to wait until morning.  I came downstairs and stood in the bathroom leaning over the toilet with my contractions coming fast and furious.  I tried the TENS machine but that didn’t really work for me.  Paul was in the dining room putting together the birthing pool which I got into as soon as it was ready.  The relief was immense.  I had heard that water was the most effective pain relief next to an epidural – I can well believe that.

I had four midwives looking after me and the babies and they all arrived at my house in time.  It was all happening so quickly and Olivia was born in the pool at 11.55pm.  She shot out and I heard her crying straight away.  I stood up and held my baby; I was elated and also amazed that my babies would have their own birthdays.  One of my midwives held my stomach to make sure that Faith fell and engaged in the right position.  We knew she was head down so we needed to make sure she stayed that way.  We decided to wait for my labour to progress naturally however, it slowed down.  I got out of the pool to walk around and see if I could get it started again.  Four hours passed and a decision was made to break the waters around Faith as the midwife discovered they were still intact.  As soon as the waters were broken, Faith was born on the sofa, again extremely quickly.

She cried straight away and the midwife placed her on me so as I could give her a cuddle and have skin to skin contact.  Another of the midwives was looking after Olivia.  Both my babies were born healthy and I couldn’t have been happier than I was just then.

The down side was that I now had to deliver the placentae.  I was so tired but knew I had to keep going.  One of my midwives helped to keep me relaxed with hypnobirthing techniques and control my breathing.  The placentae had fused together and were not budging.  With a combination of experience from my midwives and a hot towel placed across my stomach, the placenta moved and came away.  If it hadn’t been for the determination and skill of the team of midwives, I think I would have ended up in hospital with a retained placenta and that would have been disappointing after going through the entire birth at home.

So all was well.  I was in good health and although extremely tired, felt elated and proud that I had accomplished the birth I wanted.  My husband Paul was fantastic during and after the birth and I couldn’t have asked for a more supportive birthing partner.

A home birth is not for everyone and if there had been a health issue with either myself or my babies, I would have chosen hospital care.

I wanted to share my story so as other women can see that you do have choices during pregnancy even when you are having twins and you can make decisions that are right for you.  For more information about twin and multiple pregnancies visit www.tamba.org.uk

Donna has also set up a website which offers information about homebirth; she offers a free ebook at www.happyhomebirth.com

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.

Yesterday I was asked to speak at the Hinchingbrooke Maternity Services Liaison Committee AGM.  I think it went okay.  The title of my talk was Normal Birth Successes and I spoke about some of the clients I have in my Independent Midwifery Practice www.3shiresmidwife.co.uk (obviously stories are anonymized to protect client confidentiality).

I spoke about five beautiful births, one was a lovely waterbirth of a 10lb plus baby, another was a normal birth when the mother had been so frightened that she was planning an elective caesarean when she booked me.  There was also a story of a woman whose first baby had been born by caesarean, her second had been a forceps delivery and her third son (11lb) was born, at home, at Term + 18 days and a client whose first baby was born at home in the breech position and finally a client expecting her first babies who had twins at home.

I spoke about the benefits of having a known midwife at the birth, women are:

  • more likely to have a normal birth
  • less likely to have a caesarean or forceps delivery
  • have shorter labours
  • need less drugs
  • more likely to breastfeed
  • more likely to be happy with their experience
  • less likely to experience postnatal depression

All outcomes are improved when women have a midwife they know and trust.

I often work with women who are considered to be “high risk”, but these brave women sometimes make the difficult choice to labour at home because they want to be left alone, in an unpressurised environment, to get on with their labour in peace.  We know that oxytocin (the hormone needed for labour) flows better when women are relaxed and feel safe.  Often the journey to hospital, or meeting a new midwife will be enough to stop contractions (if only temporarily).

I am passionate about caseload (or one-to-one) midwifery – I believe every woman deserves to have a midwife she knows with her throughout her pregnancy and birth journey.  I fully appreciate the difficulties this provides for an under-staffed, under-resourced health service – but there are many areas that make this work for a large majority of their clients – why can we not make this a reality for more women?

There are several campaigns to improve things for women (and midwives), please visit  www.independentmidwives.org.uk or www.onemotheronemidwife.org.uk for details.


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