Valerie Gommon Midwife’s Blog

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In recent years most breech babies have been born by caesarean section in the UK.  Doctors usually suggest that a caesarean is the preferred option, however some midwives and doctors do not necessarily agree and certainly some mothers prefer to attempt a vaginal birth.

There is an excellent resource written by Jane Evans called “Breech Birth – What are my options?” available from www.aims.org.uk which talks about all the options.

If you should find your baby in the breech position there are several things you can try in an attempt to turn the baby cephalic (or head down).

First of all you could ask your doctor about External Cephalic Version (ECV) when a doctor attempts to manually turn the baby (from the outside).  This is done under very carefully controlled conditions; usually on labour ward just in case the baby becomes distressed and a caesarean is needed.  ECV can be quite uncomfortable and even painful but does have a reasonable success rate.

I always think it is worth considering alternatives, be that acupuncture, homoeopathy or chiropractic.  After all you have nothing to lose and they may well be successful.

Another suggestion is to lie at an angle, either on pillows or ironing board, with your head down and feet up and help the baby to turn over this way.  The theory is that this angle helps the baby tuck their head, thus making it easier for them to flip over, like doing a somersault.  It is recommended doing this fifteen to twenty minutes two to three times a day as early as 32 weeks and until the baby turns head down.   At the same time try to relax and visualise the baby moving into a head down position – even try to communicate with the baby and “tell” him/her to go head down if they can.

Another version of this would be to try few somersaults in the swimming pool (if you can manage it!).

Massage, either used alone or in combination with other ideas mentioned here, such as the “breech tilt” may be helpful.  Simply rub both hands wide and flat around the belly in the direction you want the baby to turn.  Both hands should stay opposite each other and move circularly, around the baby.

A slightly more drastic option is to place an ice pack (do not place directly on your skin) or even a frozen bag of peas against the top of your uterus may cause your baby to attempt to turn it’s head away from the cold temperature, or some people talk about shining a torch on their abdomen to direct the baby to the bottom of the uterus – weird and wacky, but worth a try … you’ve not got anything to lose!

If you want to speak to a midwife about any of these ideas you can always contact me info@3shiresmidwife.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!

It has been a hard week for Milton Keynes Maternity Unit and for midwifery in general.

Milton Keynes has been severely criticised for staffing shortages which may have led to the death of a baby earlier this year; the Albany Midwifery Practice has been suspended and a midwife hung herself after a baby died.  Tragic.

I trained at Milton Keynes General and I know the staff do a fantastic job under very difficult circumstances – it is obvious that staffing is an issue and this is one of the reasons I left the NHS to work in Independent Practice – I just wanted to be able to give a better standard of care to clients and to give continuity so that women know the midwife who will deliver their baby.  I feel so very sad for the woman and the staff involved.  My only hope is that the service will be better funded as a result, but in the meantime local women will be frightened and this is sad.

Most women will receive safe care in Milton Keynes and from the NHS – the NHS is excellent at delivering acute or emergency care – but what they probably won’t receive is the extra TLC to make the experience special – that is down to the individual midwife and luck depending upon how busy the Unit is.

The excellent Albany Practice in London, which has for many years provided amazing NHS care, has also been closed.  There is a campaign to save it at www.savethealbany.org.uk.

Independent Midwifery is always under threat as the Government insist we must get Professional Indemnity Insurance despite it not being commercially available.  Go to www.kentmidwiferypractice.net to support our campaign.

Midwifery in this country is severely under threat – we must fight to keep midwifery alive!

Sadly a midwife took her own life when a baby she had cared for died.  She mistakenly thought that she was to blame.  How desperately sad that midwives feel so afraid.  We do a difficult job and some babies will die no matter how hard we try to save them.  Midwives, in general, do the job because they care – the vast majority will do their very best for the clients they care for – we need to be supported, not witch hunted and blamed.

I can be contacted at www.3shiresmidwife.co.uk / info@3shiresmidwife.co.uk

Tomorrow I shall be at Friars Square Shopping Centre, Aylesbury – being a midwife (well not literally hands on I hope).

It is an opportunity to speak about anything related to pregnancy, birth and early parenting and also to promote my Independent Midwifery Practice www.3shiresmidwife.co.uk and my www.BirthIndex.co.uk website.  Come and say hello!

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!

Joanna Moorhead writes in The Guardian about how hospitals are trying to reduce the trend of repeat caesareans www.guardian.co.uk/lifeandstyle/2009/jun/16/caesarean-elective-section-giving-birth

The caesarean section rate is shockingly high.  The Association for Improvements in Maternity Services (AIMS) wrote in 2004 that the caesarean rates had continued to rise to 23 per cent, but many hospitals had rates approaching 30 per cent, indeed The Portland private maternity hospital had almost a 90% section rate.  The national caesarean section rate has continued to rise and in 2007 – 2008 was quoted as 24.6% .

Moorhead’s article highlights the dilemma – one woman was encouraged to attempt a vaginal birth after having had a caesarean first time around – sadly this woman ended up with a repeat caesarean however another woman was supported by a sympathetic obstetrician and given information about the benefits of trying for a normal birth – this woman went on to have a normal birth and was very happy with the outcome.

In fact the chances of having a vaginal birth after a caesarean are actually very good (this is obviously something you will need to discuss with your midwife and obstetrician) and I am happy to report that I have supported many women to achieve this.  There are some women however who will need a caesarean and we need to be careful not to make them feel that they have failed when a caesarean is necessary.  It is important to remember that without recourse to good medical help some women and babies would not survive!

If this is something you wish to discuss further I would be happy to speak to you, feel free to contact me by email info@3shiresmidwife.co.uk

I have also been given a copy of “Real Healing after Caesarean” by Martha Jesty which I confess I still have to read!

I’ve been quiet lately as I’ve been busy with births and also taken a few days out with my family – life as an Independent Midwife can get busy and I’m now gearing up for the next babies!  www.3shiresmidwife.co.uk

In the press this week was another Freebirthing article in The Independent www.independent.co.uk/life-style/health-and-families/healthy-living/first-person-i-gave-birth-without-any-medical-help-1739831.html Cher Sievey gave birth to her second daughter without medical assistance and was just supported by her partner.

I have previously written about Freebirthing https://midwifevalerie.wordpress.com/2009/05/03/freebirthing-unassisted-birth/ and whilst certainly not condoning unattended birthing I do understand the reasons that some women are reluctant to seek the support of doctors and midwives.


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