Home births are down

How can we empower and educate YOUNG mums to recognise home birth as a reasonable choice?

http://www.rcm.org.uk/midwives/news/fewer-women-are-giving-birth-at-home/?utm_source=Adestra&utm_medium=email&utm_term=

ONE TO ONE MIDWIVES IN THE WIRRAL

A private firm of midwives is now providing one to one care for mums in the Wirral and Birkenhead - under contract to the NHS! And - this is the top bit - they have INSURANCE for intrapartum care. Yes, independent midwives INSURED to do births under contract to the NHS.

Perhaps the awful Albany Midwives story was not in vain.

Increasing the chances of normal birth at Chelsea and Westminster

I'm on two Maternity Services Liaison Committees in my area; I'm part of the "e-group" of interested parties who send in opinions about new developments at Chelsea and Westminster and I've just joined the Queen Charlotte's and Chelsea Hospital committee which, as so many of my NCT clients are QCCH customers, I hope to get closely involved in.
At present I have to say C & W are making the running in the race to normalise birth. Firstly the hospital saw a healthy increase in home birth rates recently, not by accident but thanks to a pro-active midwife, Anne-Marie Mathews. Secondly there are plans to put up a lovely poster headed "Birth matters: keep it natural" in the labour ward which gives easy quick advice for increasing your chances of a normal birth.
A lead midwife, Annabel Bryant, has designed the poster and it just beautifully sums up what I do with a client in nine simple bullet points! I am so thrilled by this idea that I hope she won't mind me repeating the list here:

·        Encourage me to stay upright and mobile

·        Help me to adopt comfortable positions

·        Coach me with my breathing and relaxation techniques

·        Support me with massage

·        Offer me immersion in water

·        Play the music of my choice

·        Keep the lights low

·        Respect my privacy and dignity

SHIFT CHANGE SYNDROME

I've kept myself rather out of the doula world this year. Too many worries at home mean I've cut right back on this, my favourite work, because the emotional burden is just too much; I know how to put boundaries between work and home life, sure, but as a doula one is shouldering the emotional life of another family besides one's own and right now, without going into details, my own is quite enough to be getting on with.
But when an antenatal teacher colleague rang me yesterday morning asking to have a quick chat with her brother, whose wife was in labour, I could not resist the opportunity for a bit of long-distance doula-ing.
After several dud attempts to call the father to be, who was having trouble finding a phone signal, I got through to him and from his slightly disjointed, utterly worn-out account this was the picture:
First time mum R. had been in labour about 36 hours on and off. She had gone to the nice local midwife-led birthing centre in the evening and was found to be 4 cm dilated; got in and out of the pool overnight; by 7am was up to 9cm dilated. So far so good. But by 10am the midwife was now suggesting she "go to hospital for help" (synto? epidural? ventouse? she didn't specify) because mum was exhausted and had been "stuck" at 9cm for about  3 hours and her contractions were slowing down.

His voice breaking with tiredness, the dad asked me - "Shouldn't we go to hospital? R is completely exhausted, and they keep checking the hearbeat which makes it hard for her to rest, and who are we to ignore the advice of a midwife of 30 years experience?"

Any doulas out there recognise this narrative? It's what I am tempted to name "shift change syndrome". My first question was: "How's the baby's heartbeat?"

"Oh, fine," he said. So no problem there. No medical reason, as far as the baby's concerned, to get doctors in as yet.
R was kneeling up on the bed leaning over the raised end of the bed, sucking on Entonox.

I considered the facts: simply it looks as though a first time mum has laboured well through the hours of darkness, and contractions are getting a bit further apart when three things happen at once:

1. Daylight comes, which often brings with it a slowing down of labour, whatever stage things are at.
2. Mum's cervix gets to a point of dilation where the head is no longer pressing so vigorously as before on it to stimulate oxytocin production.
3. There is a change of personnel just as she was reaching 9/10 centimetres dilation. The by now trusted night shift midwife says a reluctant good-bye at a critical moment, and a new face appears, someone who hasn't been present through the whole labour story but enters the room and puts her own interpretation on the scene. It doesn't help that it happens to be the sort of midwife who boasts that she has 30 years' experience (which means she was trained at a time when, let's face it, mothers were still expected to labour on their backs and do what the doctor told them). Even if, though, R's care had been taken over by a more subtle personality, the change in carer would have had a powerful effect on her labour, inducing the fear of the new -  which causes an adrenalin bounce and, again, depresses oxytocin production. But to be taken charge of by someone whose words suggest powerfully to R that she is not coping, that she "can't do it on her own"...catastrophic.

So I said: "OK, suppose you do go to the hospital (a 30 minute drive). It's now 10.15am. Believe me, if she wants an epidural it's going to be nearly lunchtime before she actually gets it. The drive will slow down labour. The epidural will probably slow it down too though it would let her rest. The journey might slow her labour down even more. And if it doesn't, suppose she is starting to want to push while she's in transit? That's going to be really unpleasant for her and she might as well have stayed in the birth centre."

"But she's exhausted!"
"Exhaustion goes with the territory at the end of labour," I said, and wondered if I'd been too cruel, but pressed on.

 "The truth is that it's all nearly over; and the truth is that she can do it - her body will give her an adrenalin shot when she needs the extra effort to push. What she needs now is someone there who believes she can do it -  and she needs an oxytocin boost. Why not go back in, close the curtains, give her lots of physical contact, yes, give her a big cuddle, try nipple stimulation, and tell her she can do it and that you believe in her. Oh, and see if you can get her to cut back on the Entonox - just a few puffs at a time, any more isn't helping."

He staggered off. I didn't hear anything for a while; I assumed as I usually do that I had been too cruel, that she had gone to hospital, the baby had been malpositioned and wasn't going to come down in a month of Sundays, she had required epidural, synto, ventouse, forceps, the whole dog's breakfast...

Then a text from my friend: R had decided to take my suggestion and stay put in the midwife-led birth centre - and gave birth beautifully and naturally to her baby daughter just two hours after I'd spoken to her husband. 

Hooray! If only doula-ing was always this easy! But, remember: this was a mum who WANTED a natural birth. If she had been in a consultant-led unit from the word go, I wonder if she would have been able to resist the "30 years experience" midwife's negative suggestions?

This episode has got me thinking a lot not just about how much I miss being a birth doula...but also about what happens when the midwives change shift at a hospital or birth centre birth (home birth midwives generally stick around for the duration) and I feel I should warn my clients and classes of how this will affect them.

Firstly, labour may slow down and you will need to get to know this new person FAST so that mum can feel comfortable with her. Once mum has relaxed, and "forgotten" about the new person, things will hot up again.
Increased tension may cause mum to feel pain more. Again, once she's got accustomed to the new person and relaxed again, her endorphins will kick back in.
The second shift midwife hasn't seen the mum labouring before. She doesn't know her. She needs to be filled in on what's happened. She has her colleague's notes to look at - but I believe she also needs to listen to the partner and the mum (if mum feels like talking).
So here are my tips for avoiding SHIFT CHANGE SYNDROME:

• You have hopefully built up a good relationship with the previous midwife; make the most of this by telling her exactly what you want conveyed to her successor. A job for the partner.
• Have another copy of the birth preferences handy; if you've written this document out in the way I advise my clients and classes to, then it will give an instant snapshot of what kind of woman you are and what your aspirations are.
• Try and have the partner field all the questions, not the mum, so that mum's focus is not broken.
• Ask the midwife a few questions back - you need to get to know her very fast indeed so be nosy!
• The change in personnel, with questions and conversation, may break the mood and bring mum out of her "zone" and that's not good for the labour. HypnoBirthing couples may find it a good time to do the Birth Companion's Deepener script - or to do any other deepening script that they think will help mum to zone in. (It might impresse the new midwife, too. )
• See the shift change positively, as a chance for a change in scene or mood that YOU are comfortable with. For example, if you are free of moorings, lines and tubes, take a walk down the corridor, visit the loo, change the music.

Don't assume from what I have written here that shift change is always a danger point. I've seen a brilliant, inspirational "second shift" midwife work absolute wonders with a tired mum who was beginning to lose heart and being intimidated by a knife-wielding consultant. She was just one of those people who had the experience and confidence to know that this was not a time for "poor old you" but a time for "OK, Kathy, you gotta get this baby out now - the doctors are talking about caesareans. I want you up and pushing. Put the gas down and get to work, kiddo." (An approach which can go disastrously wrong, by the way.)

And there have been "first shift" midwives that I was heartily glad to see the back of, as well as some who simply stay over past the end of their shift because they want to see the job through.

The NHS midwife is one of the most incredible health professionals in the universe; but she is not a mind-reader. Make her understand what YOU want and she will then be best placed to help you.

www.birthhypnosis.net

Nestle - what would we do without them?

What would we do without those brilliant people at Nestle?

As though being the kind and generous global food and drinks giant which has done SO MUCH to introduce unenlightened women of the developing world to the elegant, civilised art of feeding their babies 

 - in a way which, while it may have a few easily waved-away side effects (poor baby growth due to mothers trying to skimp on the stuff, limited protection against infection, dodgy hygiene, use of hard-earned pennies that could go elsewhere) DOES have the great benefit of making MORE MONEY for Nestle -

WERE NOT ENOUGH,

those clever people in the lovely, clean Nestle labs have come up with a true miracle of science: 

THE WORLD'S FIRST COMPREHENSIVE INFANT AND TODDLER NUTRITION SYSTEM!!!!!

here's the link to this great advance for humankind:

http://www.nestle.com/Media/NewsAndFeatures/Pages/Nestle-launches-BabyNes-first-comprehensive-nutrition-system-for-babies-Switzerland.aspx

And here's a picture of it in action:

D'oh! Silly me.

I just pasted in a picture of a woman breastfeeding her baby by mistake.

I'm such a klutz with this blogging business.

I mean, who on earth but a daft old non-techy would absent-mindedly think THIS was what is meant by "the world’s first comprehensive nutrition system for infants and toddlers"

I've just looked again at the Nestle website and I must have missed the bit where it says that the world's first comprehensive nutrituion system for infants and toddlers is "based on Nestlé’s latest scientific achievements in baby nutrition and systems technology"?

Aren't I just an old fluff-head.

 What could POSSIBLY have made me think that human lactation is any match for the global food and drinks giant's "unmatched expertise in baby nutrition gained over 145 years since the invention of Farine Lactée by Henri Nestlé" ?

No, HERE'S a picture of the world's FIRST COMPREHENSIVE INFANT FEEDING SYSTEM:

As if you could confuse the two!

I mean look at all the advantages of the "BabyNes" (for so it is named).

It hasn't been trialled for over 70 million years.

It doesn't change the nutritional content of the milk with the needs of the baby throughout the day.

It requires sterilising, measuring, checking.

It is not free.

It is not disposable or ecofriendly and it needs a power source.

It is not so easily packaged that you don't even have to remember to take it with you when you go out.

In fact, it's hard to see how we have managed without it all these years.

It says on the BabyNes page that Nestle "supports breastfeeding for the first six months of a baby's life".

I wonder how they do that.

I'm sure they have a way. I just haven't noticed it yet. 

On the other hand...wouldn't it be wonderful, if Nestle had just stuck to making great chocolate bars?

New guidelines on NHS Caesareans published by NICE

The National Institute for Health and Clinical Excellence has started the process of updating its guidance on caesarean births with more emphasis on explaining to women what the risks and alternatives are.
The guidelines are up for consultation at present. They propose that women who have multiple C-sections should be informed that their risk of bladder damage etc is as high as if they have a vaginal delivery.
So...they aren't told now?
The guidelines also suggest that a woman who says she wants a CS because she is terrified of labour should be referred to an appropriate healthcare professional to talk over her fears.
So...there are doctors who simply say, "yes, absolutely" and book a woman in for major abdominal surgery without a thought for what mental torment might have brought her to this point?
Rather revealing.

Water birth and infection risk

A study which concludes that water birth does NOT increase infection risk in mothers or babies. They also found that water birth reduced the need for analgesic drugs and shortened first and second stage labour. Result! So please could more hospitals invest in wireless monitoring kits so as to reduce the number of women who get told "you can't use the pool because..blah blah blah-di-blah...."

Women who join my home birth group here in beautiful rural (not) Shepherds Bush get a 10% discount off a well-known brand of birthing pool. Just mentioning it.

Pre-eclampsia: has this study found a simple, low cost dietary answer to protecting women?

This is a really interesting study. Did you realise that pre-eclampsia might be linked to dietary factors?

The BMJ has published a study done in Mexico involving women at high risk of pre-eclampsia. The women given food bars with high supplements of L-arginine (an amino-acid) and anti-oxidant vitamins showed a quite dramatic decrease in pre-eclampsia.

Only thing is...Mexico's not a very rich country so with all due respect it may be that the women involved were not getting a good diet.  In countries where women normally have a good balanced diet with the requisite amounts of dairy products, poultry and plant protein sources then maybe these levels of L-arginine and anti-oxidants are reached in the general population.

All the same, it's all the more reason to lay off the fizzy drinks and pile on the yoghurt, milk, chicken breasts, wholemeal bread, nuts, lentils...all the usual suspects!

Actually when I think of it, this might be just another study which concludes, "good food is good for you".

From the BMJ website (links below)

(1) New study suggests dietary supplement can protect against pre-eclampsia
(Research: Effect of supplementation during pregnancy with L-arginine and antioxidant vitamins in medical food on pre-eclampsia in high risk population: randomised controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.d2901
(Editorial: Can a dietary supplement prevent pre-eclampsia?)
http://www.bmj.com/cgi/doi/10.1136/bmj.d2777
A dietary supplement containing an amino acid and antioxidant vitamins, given to pregnant women at high risk of pre-eclampsia, can reduce the occurrence of the disease, finds a study published on bmj.com today.
Pre-eclampsia is a serious condition where abnormally high blood pressure and other disturbances develop during pregnancy. It affects about 5% of all first-time pregnancies and is dangerous for both mother and child.
Pre-eclampsia is thought to be linked to a deficiency in L-arginine, an amino acid that helps to maintain a healthy blood flow during pregnancy. Some experts also think that antioxidant vitamins can help protect against the condition.
So a team of researchers in Mexico and the United States set out to test the theory that a combination of L-arginine and antioxidants would prevent the development of pre-eclampsia in high risk women.
The study took place at a hospital in Mexico City. Pregnant women at high risk of pre-eclampsia were randomly divided into three groups: 228 received daily food bars containing both L-arginine and antioxidant vitamins, 222 received bars containing only vitamins, and 222 received placebo bars (containing no L-arginine or vitamins).
The supplements began when women were around 20 weeks pregnant and continued until delivery. Blood pressure and L-arginine levels were measured every three to four weeks at the hospital clinic.
The proportion of women developing pre-eclampsia was 30.2% in the placebo group, 22.5% in the vitamin only group, and 12.7% in the L-arginine plus vitamin group.
This means that women in the L-arginine plus vitamin group were significantly less likely to develop pre-eclampsia compared with the placebo group. However, vitamins alone did not significantly reduce the occurrence of pre-eclampsia.
The team also found that L-arginine plus vitamins significantly reduced the risk of premature birth compared with placebo.
"This relatively simple and low cost intervention may have value in reducing the risk of pre-eclampsia and associated preterm birth," conclude the authors. However, they say that further study is needed to determine whether these results can be repeated and to identify whether they are due to L-arginine alone or the combination of L-arginine and antioxidant vitamins.
This trial reports an important finding but crucial questions remain, say two UK experts in an accompanying editorial. For instance, how do L-arginine and vitamins work together, what are the potential harmful effects, and what are the effects in other settings and populations?
They suggest that, before more trials are started, a rigorous systematic review is needed "of the numerous inconsistent strands of evidence relating to L-arginine and its possible effects on pre-eclampsia."
Contacts:
Research: Professor Felipe Vadillo-Ortega, Department of Experimental Medicine, School of Medicine, Universidad Nacional, Autonoma de Mexico, Ciudad Universitaria, Mexico
Email: felipe.vadillo@gmail.com
Editorial: Liam Smeeth, Professor of clinical epidemiology, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Email: liam.smeeth@lshtm.ac.uk

The NHS trial of HypnoBirthing: BBC reports (sort of)

Some of my HypnoBirthing colleagues are a bit disappointed with this report from the BBC...the same old "you are getting very sleepy" cliches are trotted out, the linking is clumsy...but hey, chaps, we have come a long way. You can watch the report here:

 http://www.bbc.co.uk/news/health-13451452

Now setting the bias of reporting aside, the main thing is there IS a trial which suggests that someone somewhere has twigged the idea that if more women were properly prepared for childbirth it would increase normal birth and decrease reliance on costly interventions.

So maybe the day may come when people like me do not have to patiently explain over and over again that no, natural childbirth does not mean self-flagellation; no, hypnosis is not a stage trick; no, a doula is not a sort of shaman...

Home birth group

I've just put the dates for all future CHISWICK AND HAMMERSMITH HOME BIRTH GROUP dates in my diary right up to the end of 2012.

I've also put them on the HOME BIRTH GROUP page on my website  not to mention Facebook and I've tweeted the link with my @dailybabystuff Twitter username.

I run the Home Birth group as a casual drop-in meeting.

Typically we discuss subjects such as:

• How to arrange a home birth
• Your rights in choosing your place of birth
• Reasons why you might be advised against a home birth by medical caregivers
• How to get your home ready (not as much trouble as you might think!)
• Safety of home birth and common objections from family and friends
• Sharing experiences about home birth (The Good, the Bad and the Funny!)
• When you have to transfer to hospital

We welcome home birth mums and dads and of course midwives, doulas, grandparents - anyone who wants to find out if a home birth is the right decision for the particular birth they are involved in.

Is it reflux? Is it colic?

I've been finding out some fascinating stuff about reflux and colic and I'd like to share it with you.

Every other baby I meet these days seems to have something called reflux but an awful lot of these babies seem to have what in my day we just called colic. It's really confusing - are they the same thing?

So here's what I've found so far.

Gastric Oesophageal Reflux (GOR) is the normal phenomenon of stomach contents washing back past the oesophageal sphincter into the oesophagus. 70% of all healthy, happy, thriving babies do it several times a day. The peak period is 3-7 months and normally babies have stopped by 12-15 months old.

Gastric Oesophageal Reflux DISEASE (GORD) is when the reflux causes the baby pain and/or not to thrive because it is affecting digestion, feeding and causing damage to the oesophagus

My take on this: GOR is when the spitting up is mainly a problem for your laundry basket. GORD is when it is distressing the baby persistently and causing poor health.

“Silent reflux” – no outward signs (i.e. no regurgitation) but baby is unhappy because stomach contents are washing up a short way into the oesophagus àoesophagitis.

NB: JUST BECAUSE IT LOOKS LIKE REFLUX DOESN’T MEAN REFLUX IS CAUSING THE PROBLEM – THERE MAY BE UNDERLYING REASONS! Such as excessive gassiness, constipation, a food intolerance (especially to cow’s milk/soy milk), INFECTION, sensitivity to tobacco smoke, “colic” (baby is too little “switch off” crying) – MUM SHOULD ALWAYS CONSULT DOCTOR IF IN DOUBT (see “red flag” list)

An easy way of remembering the various solutions for GOR and GORD is:

·         Gravity – anything that helps the food go down and the air go up

·         O (= a boob!) – improve the breastfeeding technique or pattern

·         Reassurance/relaxing – anything to soothe baby (and mum)

·         Diet,  Doctors and other health professionals – medical and alternative therapy solutions

Gravity:

Baby as upright as possible during feed – eg in a wrap sling

Keep upright after feed 30 to 40 mins – a sling/carrier can help a lot

Baby upright as when over your shoulder rather than slumped in a chair (American Journal of Paediatrics, Orenstein and Whitington, October 1983)

Frequent burping BEFORE, during and after feed

Avoid car seat immediately after feed

Avoid nappies or clothing tight round tummy

Baby at 30 degrees – not flat –  in cot or on babygym

When changing nappy, put a cushion under baby’s head

Sleepcurve and special wedges

O   = a boob (Better breastfeeding)

Check the latch – getting air in?

One breast at a time, allow baby to continue until stops.  Sucking à continuous muscle movement through digestive tract àkeeps it all going down; baby emptying breast ensures baby ends with calorie-rich hind milk which stays in stomach longer; at end of feed flow is slow àless coming in at top while muscle movement still keeping things moving down.

In some cases with overactive letdown even two feeds in a row on one breast. Consider whether using a breast pump in between feeds is really helping.

Feed baby when not over-hungry so not gulping in air.

Feed baby more often to encourage smaller, more manageable feeds and more downward action.

Reassuring, relaxing and soothing

A pacifier helps baby carry on the helpful sucking action

Atmosphere calm and cosy –You are not a failure if you can’t “stop the baby crying”, you are a hero for giving baby the kind of environment that helps baby to calm self eventually

Mum relaxed with a glass of wine? (recommended by  Dr Jack Newman!)

Lying down;

Massaging Baby tummy and back, upright

Movement that is rhythmical and swaying - rocking, buggy, swing-seat, your lap, your arms

Support from others: Take turns, Find another mum with a colicky/reflux baby

Diet, Doctors (and other health professionals)

Write down everything mum eats for 3 days and log fussy episodes – is there a pattern?

Try cutting out one suspect eg dairy products for 3 days

All these foods and substances have been implicated in GOR and GORD:

cow’s milk protein, chocolate, spices, citrus, cauliflower, onions, broccoli, mustard, aspirin, decongestants, peanuts, wheat, tomatoes, cucumber, soy, apples, bananas...

 A probe or endoscopy can check for acidity and/or damage to the oesophagus.

·         Antacids  - infant Gaviscon

·         Acid blockers eg Pepcid

·         Motility improvers (muscle tone) eg Domperidone

Also many parents find relief after treatment by a cranial osteopath, herbalist.