Valerie Gommon Midwife’s Blog

Archive for the ‘waterbirth’ Category

Where to start?  Every day is different, so I’m going to give you a flavour of the sort of things I get up to.

Of course I have antenatal appointments; from the first tentative telephone enquiry I then arrange to meet up with a potential client (usually for an hour or so) so that we can discuss their past experiences, their hopes for this pregnancy, their concerns and most importantly so that they can get a “feel” as to whether they actually like and trust me.  Once a couple have decided to book me as their midwife I then usually give all their antenatal care in their own home (although I have done antenatal visits in The Bank of England medical room!).  The format of visits is that I carry out all the usual blood tests, urine and blood pressure checks, but also leave a lot of time for discussion so that over the course of the pregnancy we cover issues such as waterbirth, Vitamin K, when to call me and so on.

My clients come from a wide area – I am happy to take clients who live within approximately an hour’s radius of my home in Leighton Buzzard – so I do spend a fair bit of time driving, as well as liaising with G.P.’s and hospitals where necessary.

Four times a year I jointly organise an Antenatal Exhibition, this is an opportunity for pregnant couples to gather information about breastfeeding, pregnancy yoga, cloth nappies and the like.  We also organise Birth Preparation Workshops and am often to be found at the Community Desk in Central Milton Keynes on hand to speak to expectant parents and also regularly attend Study Day’s and midwifery meetings to ensure that I keep myself up-to-date with current research.

Obviously I spend much of my time being “on-call” for births.  My own family are now pretty much grown-up and the commitment isn’t as big as one might imagine as I rarely have more than two births during a month – it is important that I don’t over-commit myself as the whole point of what I do is that I guarantee to be there for the birth.  Babies don’t always read the text books though!  I have had three births in one week, as of course some babies do come early and some come late!  As you will appreciate, the birth is the big event, and it can on occasion go on for some time.

Baby being here doesn’t mean that my job ends!  In fact, postnatal visiting is often one of the busiest times as the family may need quite a lot of support in the early days.  The majority of my clients choose to give birth at home; however some either need to, or choose to give birth in hospital.

I visit my clients for up to four weeks postnatally and it is a joy to see the baby thriving and although discharging clients is always tinged with sadness it is also great to know that I have played a part in helping the family on to the next stage of their life.  (I do usually keep in touch, perhaps not as often as I would like, but I often get e-mails and photographs and usually pop in when I’m passing!).

So, in summary I guess the main differences between me and an NHS midwife are that you are buying my time; antenatal visits usually take around an hour and a half (instead of perhaps 10 – 15 minutes at your local surgery), are arranged more frequently and take place at a time and place to suit you. Most importantly you will receive full continuity of care – I will see you at each visit to build our relationship and plan your care and you will know that (barring exceptional circumstances) I will be with you in labour and available 24/7 for urgent help.

I am always happy to discuss anything that you are concerned about; please do feel free to call.

Written by Valerie Gommon, BA (Hons), RM, Independent Midwife

www.3shiresmidwife.co.uk 01525 385153

It has occurred to me that I haven’t written about the benefits of waterbirth.

I think the use of water in a labour and birth can be hugely beneficial; I’ll start with my own personal experience/feelings about waterbirth.  When my youngest child was born, more than twenty years ago now, waterbirths were just being talked about in the press.  I remember my husband asking me whether I wanted to consider a waterbirth and I have to say that I wasn’t interested, but then I’d already had three babies and I knew that I could cope with labour.

As a midwife, I would say that my opinion of waterbirth is only positive.  I recognise that not all women will want or need a waterbirth, but I would strongly recommend all women not to rule the use of water out.  It may be that you use water by having a bath or shower in labour; it can be hugely comforting to have shower water jetting onto your tummy or back whilst in labour.

As I see it, if we are achy or tense a bath is usually helpful.  It works in just the same way in labour; water is usually relaxing.  Another benefit is that women are much more mobile in labour and have their weight supported by the water making it easier to move around.  Lastly (dare I say it) if you are in a birthpool no one can interfere with you!  You are in your own space and are much more in control of what happens.

Most hospitals now have at least one birthing pool and if it is something that appeals to you I suggest you discuss it with your midwife and let the labour ward midwife know as soon as you arrive at the hospital.

For homebirths there is a considerable choice of birthpools available, for example rigid “bath” type pools that come with and without water heaters and inflatable pools.

I think the main benefit of the rigid pool with a heater is that you can put it up in advance of the birth and treat yourself to a relaxing “wallow” in the days leading up to the birth and also not have the stress of putting up the pool once labour starts.  The negative to these pools is that because they have a water filter you will need to put chemicals into the water to keep it clean.

The inflatable pools are very good, they are also usually cheaper than hiring a rigid pool.  The pool will be brand new (although both types have a disposable liner to ensure hygiene) and can be used again, or used as a giant paddling pool or ball pool for your children.  The soft sides of the pool are also very comfortable to lean against.

Here are a selection of companies who either hire or sell waterbirth pools:

www.thegoodbirth.co.uk – quote Valerie Gommon

www.borninwater.co.uk – quote Indy Mid discount

www.gentlewater.co.uk

www.bubbatubs.com

www.aquabirth.co.uk

www.madeinwater.co.uk

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!

Sunday 4th October, 2 – 4.30 pm

FREE Antenatal Exhibition

For pregnant women and their birth partners to find out about all aspects of pregnancy, birth and early parenting.  Exhibitors include: midwifery, breastfeeding, waterbirth, aquanatal, yoga for pregnancy, cloth nappies, ultrasound scans, complementary therapists, childcare vouchers and much more!

Venue: Church of Christ the Cornerstone (opposite Marks and Spencer), Central Milton Keynes.

Do come along to our informal and informative exhibition, or for more information you can email info@3shiresmidwife.co.uk

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.”

A birth plan is optional – it enables you to devise your own personal plan of care if this is your wish, and can be helpful to health professionals in knowing your thoughts.

It is also an opportunity to make a decision about your care on the basis of informed choice.  By compiling a birth plan, it does not imply that you want a ‘natural’ or ‘alternative’ labour and a birth plan can be changed at any point, it is just an indication of your wishes.

Whether you decide to make a birth plan or not, your care should be discussed with you and no treatment or procedures performed without a full explanation and your consent.

The following are some suggestions of things you might like to include in your birth plan:

Who you want with you for the birth (e.g your partner, a friend or both)

Pain relief (you may be keen to manage without drugs or keen to have as pain free a labour as possible, do you plan a waterbirth)

Positions for labour and birth (you may wish to be able to move around during labour and encouraged to try different positions for the birth)

Monitoring of the baby’s heartbeat (e.g. using a hand-held sonicaid to monitor the baby intermittently or being monitored continuously)

Students (whether you are happy for students to participate in, or witness your birth)

After the birth (do you want pick up the baby yourself/be given the baby or do you want the baby wrapped, do you want to discover the baby’s sex yourself, would your partner (or you) like to cut the cord)

Management of the third stage or placenta (do you want a ‘natural’ third stage or to be given the drug syntometrine

Vitamin K (do you wish your baby to receive Vitamin K either by injection/orally/not at all)

A Birth Plan is just that – a plan, it can be deviated from according to your wishes at the time!

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!


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