Valerie Gommon Midwife’s Blog

Archive for the ‘www.aims.org.uk’ Category

Following the recent screening of “Freedom for Birth” a film documentary discussing the plight of maternity services and midwifery world-wide I have put together an Action Plan of ideas that you may like to consider to support the midwives and maternity services.  Please do as much as you can to make things better for women today and our daughters in the future.

ACTION PLAN

Please consider joining the following Facebook groups:

Independent Midwives UK

Fighting for Independent Midwives

The Birth I Want

ARM Conference 2012

One Born Every Minute—The Truth

One World Birth

Human Rights in Childbirth

Face of Birth

http://www.facebook.com/pages/Podpora-pro-%C3%81gnes-Ger%C3%A9b-Support-for-%C3%81gnes-Ger%C3%A9b/139577179421729?v=wall

Websites:

The Birth I Want:

http://www.thebirthiwant.org.uk

Register an Interest in Independent Midwifery at:

http://www.independentmidwives.org.uk/

The Association of Radical Midwives—Midwifery Matters:

http://www.midwifery.org.uk/

The Association for Improvement in Maternity

Services:

http://www.aims.org.uk/

The Face of Birth

www.faceofbirth.com

Sign the petitions:

http://www.change.org/en-GB/petitions/amnesty-international-europe-amnesty-international-to-save-persecuted-midwives-in-europe?utm_campaign=autopublish&utm_medium=facebook&utm_source=share_petition&utm_term=4998292

http://you.38degrees.org.uk/petitions/choice-for-mothers-to-be-saves-nhs-money

http://epetitions.direct.gov.uk/petitions/34513

 

View the short version of “Freedom for Birth” available November 2012

Write a letter of support for Agnes to President of Hungary, János Áder ugyfelkapu@keh.hu

 

STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS

Royal College of Midwives (RCM), National Childbirth Trust (NCT) Independent Midwives UK (IM UK) Association of Radical Midwives (ARM) Association for Improvements in Maternity Services (AIMS) and the Albany Mums Support Group present:

THE ‘RECLAIMING BIRTH’ RALLY SUNDAY, MARCH 7th 2010

Please consider joining us for this important Rally to support mothers and babies.  “Mothers and babies are the foundations of our society, what is more important than getting the foundations right?”

This is a once in a lifetime opportunity – with an election coming up – to send a very loud message, there is a real sense of all the different stakeholders being united in one voice and it could, with hindsight be seen as the turning point for the midwifery profession.

We demand that all women should have a midwife they can get to know, be able to access home birth, a local birth centre, and that there should be independent midwifery available as an option for women to choose.

Meet at 1.00PM in Geraldine Mary Harmsworth Park, Lambeth Road, SE14EQ

We will march to Whitehall to hand in a petition to the Health Minister and letters to the Prime Minister

Master of Ceremonies: Peter Duncan.  Speakers include: Professor Wendy Savage, AIMS Chair Beverley Beech, Albany Midwife Becky Reed, IM UK Board Member Annie Francis, NCT CEO Belinda Phipps, Albany Mums Support Group campaigner Emma Neamish and Duncan Fisher OBE

PLEASE TELL EVERYONE ABOUT THIS IMPORTANT RALLY.

The first thing I should say is that Induction of labour is not an easy option and should, in my opinion, be avoided if at all possible.

There are many debates about when women should be induced – the NICE (National Institute of Health and Clinical Excellence) suggest that women should be OFFERED induction at between 41 and 42 weeks of pregnancy www.nice.org.uk/nicemedia/pdf/CG70quickrefguide.pdf

Of course there may be medical reasons for an induction, and these should carefully be discussed with your midwife and doctor, however there are also risks associated with induction, for example you are more likely to have a longer, more painful labour after an induction and you are more likely to need some help for example a ventouse or forceps delivery or a caesarean section.

If it is agreed that an induction is preferable, I would urge you to try “alternative” methods or induction before resorting to a surgical induction https://midwifevalerie.wordpress.com/2008/12/09/alternatives-t…ital-induction/

Although methods of induction vary slightly from area to area, the principles of a “surgical” induction will involve you going into the hospital where you will first be checked over (blood pressure, urinalysis, abdominal palpation), your baby’s heartbeat will then be monitored for a period of time to ensure that the baby is well and that it is safe to proceed with an induction.

You will then be assessed internally to ascertain the best and safest method to induce you.  If it is your first baby and you are not yet in labour it is likely that the doctor will prescribe a drug called “Prostin” which is inserted into your vagina to soften your cervix with the aim of starting labour.  (Prostin is an artificial preparation of the hormone prostaglandin which is naturally present and involved in the labour process.)

Your baby may well be monitored for a period after the insertion of prostin – we want to ensure that s/he suffers no adverse reaction to the drug, – the monitoring is performed by placing two elastic belts around your abdomen to hold a “transducer” (a plastic probe) onto your tummy to obtain a print-out of the baby’s heart pattern (this is just a glorified version of the sonicaid that the midwife uses antenatally to listen to your baby).

Once the midwife is reassured she will be happy for you to get up and perhaps go for a walk or go to the hospital restaurant – it is a good idea to eat as you will need lots of energy when you are in labour!  Some hospitals will also allow you to go home and wait for labour.

Prostin does not always work first time, indeed often women need two, three or sometimes more doses and these are usually repeated at 6 hourly intervals.

An alternative to prostin is to break your waters – this can only be done if your cervix has already started to open – this is more likely if this is not your first baby, or if you have had prostin which has started the process but not put you into labour.

Breaking the waters is not particularly painful, although it can be very uncomfortable.   The midwife or doctor will need to do an internal examination and will attempt to “pop” the bag of waters that your baby is inside.  We use a plastic hook and literally try to burst the balloon of water!

Very often after the waters have broken labour will naturally start within a couple of hours, so again we wait … you can go off for another walk (are you getting a sense of the timescale here … an induction can go on for several days, so don’t expect things to happen in a hurry!).

If at this point the woman still is not in labour we usually suggest giving her a drip with a drug called synotocinon which usually starts uterine contractions.  These contractions are frequently more painful than a natural labour and because we are giving a drug we will also need to continuously monitor the baby’s heartbeat meaning that you are somewhat constrained in your movements (you can still stand by the bed or sit in a chair though).

In a few cases despite all our best efforts none of this will work and we proceed to a caesarean section.

Despite my doom and gloom, many women who are induced successfully labour and go on to have a normal birth, but to give yourself the best chance of a normal birth think carefully about whether an induction is right for you.  The decision as to whether you are induced or not should be made by YOU, in consultation with your doctor and midwife, remember it is your body and your baby, you have the right not to be induced.  A normal pregnancy is defined as between 37 and 42 weeks – so you are not even overdue until you get passed 42 weeks!

More information can be found in “Induction – do I really need it?” available from www.aims.org.uk or as always I am very happy to speak to you info@3shiresmidwife.co.uk

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

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.”

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!


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