Valerie Gommon Midwife’s Blog

Archive for the ‘www.bbc.co.uk’ Category

 
Milton Keynes General Hospital is in the news this week with a story about a client who allegedly objected to non-white staff being in the delivery room. Apparently hospital staff have complained to the Equality and Human Rights Commission about the way the situation was handled earlier this month when an unnamed white woman had a Caesarean section at the hospital. The hospital said it had begun a full investigation and said it is thought to be the first time such a request has been made to them.

http://news.bbc.co.uk/1/hi/england/beds/bucks/herts/8330102.stm

http://www.dailymail.co.uk/news/article-1223598/Pregnant-woman-race-demand-Buckinghamshire-hospital-facing-prosecution.html

Research suggests exercise during pregnancy can be good for the developing baby as well as for the mother www.news.bbc.co.uk/1/hi/health/8002560.stm

A study conducted by a team from the Kansas City University of Medicine and Biosciences suggests that exercise is linked to better foetal heart health and nervous system development.

This small scale research compared women who took moderate exercise with pregnant women who did not exercise regularly.

Dr Linda May, who led the study, said: “Foetal breathing movement and the nervous system were more mature in babies exposed to exercise.”  She went on to say that further research was needed, both to look at more pregnancies and to evaluate the health of babies once they had been born.

Obstetrician Patrick O’Brien said that although exercise is good for pregnant women they should consult their midwives and doctors because excessive exercise during pregnancy could be dangerous for the unborn baby; particularly if a woman becomes too hot or lets their heart rate go over 130 beats per minute, but he went on to say that there was is no increased risk of miscarriage or premature labour linked to exercise.  He also advised that women exercise at a level that enables them to comfortably hold a conversation.

As a midwife I advise clients that walking and swimming are excellent forms of exercise as are yoga or pilates taught by an appropriate person.  I would not advise strenous new exercise during pregnancy, but have had clients who have continued with their training, for example running during pregnancy.

I have recently met Faye Cooke who is based in Bedfordshire and near to Milton Keynes www.exercise4you.co.uk and feel confident to recommend her services to clients for antenatal and postnatal exercise classes.

Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html

I am probably not going to be able to do this subject justice in a short blog posting, but the subject was being discussed this afternoon on Radio 4 – “Am I Normal?” presented by Vivienne Parry www.bbc.co.uk/radio4/science/.

The programme debated many interesting issues, for example the increase in the diagnosis of postnatal depression and the changing role of women in society.

I apologise that the information below is perhaps written in a slightly “academic” or technical style as it is taken from an essay I submitted on my degree programme, however I think the information is largely valuable – if you feel you would like to discuss anything I have written do feel free to contact me info@3shiresmidwife.co.uk or telephone 01908 511247.

I also feel very strongly that women are often given inadequate support in the postnatal period.  Indeed many women are reporting receiving only two or three postnatal visits from NHS midwives (and then it is not always a trained midwife who visits) and Health Visiting services are also very stretched.  As an Independent Midwife I am able to offer far more support postnatally and this is something that I believe all women deserve.

If you are struggling DO speak to your midwife, health visitor or GP – make a nuisance of yourself!  Self-help groups and lay groups like the National Childbirth Trust (NCT) www.nct.org.uk, La Leche League (LLL) www.laleche.org.uk Meet A Mum Association (MAMA) www.mama.co.uk and Association for Post Natal Illness (APNI) www.apni.org can all be very supportive.

Postnatal Depression

It can be predicted that the early days, months and even years after childbirth are a time of stress for the woman and her family.  Indeed there are also the major physiological changes from the pregnant state into lactation and the return to the usual non-pregnant state of monthly menstruation cycles.  These changes are normal physiological reactions to the changes undergone by the woman (Stables, 1999), often women as said to experience “baby blues” at this time.  Some women, however, go on to experience stronger reactions that may be described as “postnatal depression” or occasionally “puerperal psychosis” (Sweet, 1997).  A few women will be so traumatised by their experience that they develop “post traumatic stress disorder”.

Baby blues” is considered by many to be a normal phenomenon that happens around three or four days postpartum, and is associated with the rapid physiological and psychological changes taking place.  Many women experience a degree of transient emotional lability and changes or mood that is self-limiting and usually resolves quickly.  (Ball, 1996).

Postnatal depression (PND) is more severe.  Cox, 1986 suggests that 10% of all mothers develop clinical depression following childbirth and that a further 10% exhibit considerable emotional distress.  The onset is gradual and may last for 3-6 months (or longer).  PND is a reactive illness and can be associated with other stress factors (i.e. moving house, marital tension and low self-esteem).  Women suffering PND are usually able to sleep, but continue to feel tired and exhausted, often feeling worse as the day progresses.  PND can cause disruption to family life, and can affect mother-child relationships.  (Ball, 1996).

In recent years Health Visitors have been encouraged to use the Edinburgh Postnatal Depression Scale (developed by Cox et al, 1987) as a tool to detect postnatal depression.  Some authors have suggested that midwives should use the Edinburgh Postnatal Depression Scale (EPDS), (Sweet, 1997 and Clements, 1995) but the tool is not foolproof.   Postnatal women are asked to identify and report on their feelings and they may choose not to disclose feelings.  Feedback suggests that the scale is a useful tool, and can enable further discussion to ensue.  If indicated, the woman may then be offered “listening visits” when the Health Visitor will set aside time to talk on a one-to-one basis with the woman.  Some women may also be helped by medication and the Health Visitor will liaise with the General Practitioner and indeed the wider mental health team if it is thought appropriate.  It is thought that early treatment is most effective, midwives and health visitors should therefore be alert for early symptoms such as excessive anxiety and depression.  (Church and Scanlan, 2002, Bryant et al, 1999).

There has, however, been criticism of The Edinburgh Postnatal Depression Scale.  Robinson, 1998, suggests that it is ineffective because of indiscriminate usage, whilst Ballard et al, 1995 suggest that women often score highly on the EPDS and receive inappropriate treatment.

Puerperal psychosis is a severe form of mental illness that will affect approximately one or two mothers in 1000.  The onset is rapid and usually occurs within the first few days after delivery.  The condition presents as a depressive psychosis, manic illness and in some cases schizophrenia.  Primiparae are most often affected.  Women affected in this way need prompt admission to a psychiatric unit.  (Ball, 1996).

Women can experience Post Traumatic Stress following childbirth, this phenomenon has only been documented in the literature in recent years.  Indeed an extensive literature and internet search did not reveal any mention of post traumatic stress following childbirth until 1994 (Ralph and Alexander, 1994).

During the 1990s there were several articles discussing the merits of offering “debriefing” to postnatal women.  (Charles & Curtis, 1994, Jones, 1996, Westley, 1997, Robinson, 1998).  Interest in labour debriefing revealed that some women experience severe adverse reactions to their birth experience and it was suggested that a small number of women may experience post traumatic stress symptoms following childbirth.  The prevalence of post traumatic stress following childbirth has been estimated at between 1.5 per cent (Ayers & Pickering, 2001) and 1.7 per cent (Wijma et al, 1997), although Laing, 2001 argues that this is probably an underestimation of the problem.

I am very happy to offer a birth debrief to women within my catchment area, please see my website www.3shiresmidwife.co.uk for details.

Lastly, I should add that serious Postnatal Depression only affects a small number of women, but it is important that it is spoken about and that you seek help if you need it.

A woman in America has given birth to eight babies, and although born nine weeks prematurely, at present doctors say all of them are doing well.  The babies weighed between 1lb 8 ounces (820g) and 3lb 4oz (1.47kg) and will need to stay in Neonatal Intensive Care for some time.  It’s only the second time in the world that someone has given birth to eight babies at once, and doctors were only expecting her to have seven! www.news.bbc.co.uk/1/hi/world/americas/7852623.stm

Also in the news is the story of surrogate mother Carol Horlock who has had eleven babies for other couples and also has two children of her own. www.news.bbc.co.uk/1/hi/health/7851838.stm I am sure surrogacy takes place in most cultures, often with the surrogate mother being a family member, of course this raises huge ethical issues not to mention the emotional issues for all concerned, but wow … this is something that I personally could never have considered, I couldn’t even have parted with my eggs, but I know many couples are eternally grateful for those that are able to help them have a family.

Today I was twice invited to speak on BBC 3 Counties Radio, partly in response to this news story and also to speak about my work as an Independent Midwife – www.bbc.co.uk/threecounties/content/articles/2008/04/25/afternoon_show_feature.shtml

I had hoped to have the opportunity to discuss my new website www.BirthIndex.co.uk but the interviewer was keen to discuss my blog.

BirthIndex.co.uk was launched only three months ago has already proved popular.  The site currently covers Bedford, Milton Keynes and Northampton and aims to be THE information site for all things Pregnancy, Birth and Baby.  For example on the site you can find therapists who specialise in Pre-conceptual support, pregnancy ultrasound, swimming classes for babies and even photographers to photograph your little one!  The site has a comprehensive Links section and an interesting selection of articles and the opportunity to sign up for a regular newsletter.


Twitter