Your pregnancy, your midwife, your choice

Information

14 Dec

Personal Maternity Care Budget to be piloted in Liverpool

The 12th December 2016 saw the launch of the first pilot of the implementation of Personal Maternity Care Budgets by the Cheshire and Merseyside Pioneer. This is the first step in fulfilling one of the recommendations for the transformation of maternity services in the Better Births Report 2016. Better Births recommends that all women should have personalised care, centred on the woman, her baby and her family, based around their needs and their decisions, where they have genuine choice. Better Births also set out a vision that women should be able to choose the provider of their antenatal, birth and postnatal care and be in control of exercising those choices through their own NHS Personal Maternity Care Budget.

Initially the pilot is being rolled out by Liverpool Women’s Hospital with a handful of selected GP surgeries but the press launch has stated that other providers in the Pioneer will roll out PMCBs early in 2017. One to One Midwives, as a commissioned provider in Cheshire and Merseyside will be offered as a choice to women to use their PMCB but for One to One Midwives this will be ‘business as usual”.

One to One are already a choice option for women and their families – but what do One to One offer?

Quite simply One to One provides a service that is centred on the needs and choices of women and their families. We do this through our model of Continuity of Carer – every woman who books with One to One will be contacted by her named midwife and see her midwife for the vast majority of her antenatal visits.

One to One midwives see their women for 88% of their antenatal visits. 
One to One midwives attend 75% of the births of women that they know
One to One midwives see their women and babies for 80% of their postnatal visits.

This is what continuity of carer means to us.

What else can you expect from the One to One service?

As all care is based on your needs and choices, the number of visits is unlimited, both antenatally and postnatally and as well as face-to-face visits, you will also have access to your midwife 24 hours a day, 7 days a week by phone, text or email to discuss any concerns or advice that you may need.

The majority of visits take place in your own home, with the option to have your appointments in the evenings or at the weekend, which ensures that your partners can also participate in your care. One to One have three Pregnancy Advice Centres open in Cheshire and Merseyside and run local clinics and scan appointments out in the local community to ensure you have an additional choice of where to receive care, which will be as close to your home as possible.

One to One offers numerous social networking opportunities in our local community hubs and we also provide hypnobirthing and parent education and courses as standard.

We employ MaMAs (Mother and Midwife Assistants) to offer additional support in the antenatal as well as the postnatal period. Our MaMAs can support you with becoming more confident parents as well as providing you with practical advice and support regarding infant feeding and baby care.

Our midwives are trained to recognise and deal with any complications that occur and if necessary we can refer you to an obstetrician within a local hospital of your choice to ensure that you receive safe and appropriate care when needed.

If everything goes well with your pregnancy and you choose a homebirth, your One to One midwife will ensure that you have access to a pool (if you choose a waterbirth) and access to our KG Hynobirthing course, which can be booked directly via our One to One website.

After the birth your One to One midwife, with the support of your MaMA, will visit you at home as often as you need until at least 6 weeks after your baby has been born.

One to One Midwives are delivering what the pioneer is aiming to deliver across the rest of Cheshire and Merseyside in the future. If you want to know more about the One to One service or how you can access our care you can contact us via the following options:

o Send an enquiry via our website at: http://www.onetoonemidwives.org/enquiries 
o By telephone: 0330 3309 121
o Via your GP

To find out if One to One is available in your area, contact us on Facebook: https://www.facebook.com/OnetoOneMidwives or using any of the above contact methods.

26 Jun

Campaign for a normal birth

As a case loading midwife I love being able to empower women and families to make informed decisions about their pregnancy, birth and care they receive during and after this time. One of the tools I like to use is the Royal College of Midwives (RCM) – Campaign for normal birth: Ten top tips for midwives.

Normal is specific to each individual and my aim as a caseloading midwife is to help women and their families have a positive experience during their pregnancy, labour and birth. The RCM’s Campaign for normal birth has information for both midwives and women and can be adapted to all care settings.

One of the ten top tips is “build her a nest” and this promotes the midwife/partner/woman creating a safe environment for the woman to birth in. Regardless of whether you are birthing at home, in a midwifery led unit or obstetric unit; certain aspects can be used to help support physiological labour in all settings.

Please find below the link to the RCM Campaign for normal birth website and a short poem I have created capturing “building a nest” in labour.

Your journey is starting and instincts kick in,
Peacefully find a dark place to relax in.
Warm and secure surrounded by love.
Allowing your hormones to blossom and bud.
Privacy and quiet you must be allowed,
In your nesting environment as calm as a cloud.
Feel the support that your body can do
Confidently ending your journey
Baby and you!!!!

http://www.rcmnormalbirth.org.uk/

Post by Sarah Jurd, One to One Midwife

18 Jun

Induction of labour

There are so many discrepancies in hospitals across the UK as to when is the best time to offer an Induction of Labour (IOL). It is important to understand that an IOL is just an offer of care and like every choice you make in pregnancy, you do not have to accept it.

Your One to One midwife will talk to you about the risks and benefits of this option towards the end of your pregnancy. Your midwife can also discuss what plan of care can be put in place to reassure you if you chose to decline an IOL. We call this 'conservative management'.

An IOL is performed in hospital and can be done in many ways. The main types of induction are:

1. A pessary (a small vaginal tablet) 
2. A gel (inserted vaginally) 
3. Artificial Rupture of Membranes (breaking the waters) 
4. Intravenous Syntocinon (hormone drip given through a cannula).

The main aim of types 1 and 2 IOL is to soften and "ripen" the cervix so that your body will begin to labour and dilate the cervix without further assistance. Sometimes if this is unsuccessful in producing spontaneous tightening’s/surges you may be offered type 3 IOL, if this is unsuccessful in producing spontaneous tightening’s/surges you may be offered type 4 IOL.

IOL is a long process sometimes spanning over a 1-2 days depending on how many different stages/types of IOL is required. It is important in this time to mobilise as much as possible, eat and hydrate so that you can prime your body for labour and birth.

What are your experiences or thoughts on IOL? What are your experiences or thoughts on conservative management?

Post by Lorna, One to One midwife

02 Jun

The Expected Date of Delivery

The Expected Date of Delivery (or EDD) is something deeply ingrained in our social management of pregnancy. It may be the first question asked when someone becomes aware of a pregnancy. However, midwives know that focusing obsessively on this fixed point can cause expectant mothers much anguish and even bring about unwarranted intervention. The pressure on mothers to give birth to their baby on this day can be overwhelming.

Midwife researcher Sara Wickham calls this "fixed point expectation syndrome". She states that it is of course a natural and understandable human process and to some degree is necessary in order to manage our busy lives. However when the expectation is not met, mothers and their families can feel confused, disappointed and may be more likely to interrupt the natural pregnancy process.

The idea of substituting a wider range of probable birthing time for baby is one way to combat the disappointment often associated with EDDs. Midwife Brenda van der Kooy notes that, “as elsewhere in nature, normality has a range”.

Could it be feasible to start to refer to a Due Month instead? Indeed, as only about 4% of babies are actually born on their "due date", but most babies will make an appearance between 37 and 42 weeks gestation, it could be realistic to dismiss the EDD altogether and start to broaden the language we use when discussing when baby might be born.

What are your thoughts?

References

Davies, R (2003). “I’m ready for you, baby, why won’t you come?” How long is a pregnancy and how long is too long? New Zealand College of Midwives Journal 28(1): 8-10.

Mongelli, M (2010) Evaluation of gestation. eMedicine. emedicine.medscape.com

NHS (2010) Singleton, twin and higher order multiple deliveries by gestation and birth status, 2008-2009. NHS Information Centre for health and social care. www.hesonline.nhs.uk

Stickler, G B. (1994). Expected date of confinement (correspondence). The Journal of Family Practice 39(4): 325.

Van der Kooy, B (1994). Calculating expected date of delivery – its accuracy and relevance. Midwifery Matters 60: 4-7, 24.

Post by Sarah, One to One Midwife

23 Apr

Care of the umbilical cord

Following birth, the umbilical cord is usually clamped and cut leaving a 2-4cm stump. Some parents may choose to use umbilical cord ties to secure the cord, or choose to leave the cord attached to the placenta until it naturally separates (known as a ‘lotus birth’ and pictured below).

After birth the umbilical cord will dry, turn from a white/yellow colour to a green/black and eventually separate over the course of 5-14 days. Here are a few tips for taking care of your baby’s cord whilst this process happens:

- Keep the cord as dry as possible. It is safe to bath your baby in plain water, but ensure the cord is left to dry by exposing it to the air for a short period after drying it gently with a towel.

- Don’t use any products on the cord; for the cord to separate some bacteria must be present, and using soaps, particularly antibacterial products, can affect this process.

- Fold down the top of your baby’s nappy or use nappies that have a cut out section to avoid friction and allow air flow to the area.

- There may be a slight smell as the cord begins to separate, and the base can take on a wet or sticky appearance. If you are concerned about this, there is a large amount of discharge, the base of the cord or skin on your baby’s abdomen appears red or inflamed, or if your baby seems unwell in any way, contact your midwife as soon as possible for further advice.

(Image from Geneabirth.com)

Care of your perineum following birth

Your perineum (stretch of muscle and skin between your vagina and anus) can be tender following birth, particularly if tearing has occurred and/or stitches have been required.

The area has excellent blood flow and in almost all cases will heal very well. Below are a few tips to ease discomfort and promote healing during the days and weeks following birth.

- Ensure you have a balanced, varied diet and keep well hydrated. This will have the added bonus of assisting your milk supply and improving your energy levels.

- Ensure you exercise your pelvic floor as much as possible to improve muscle tone in the area.

- Ensure the area is kept clean as much as possible; this can be achieved by pouring warm water over the area each time you use the toilet in addition to your regular baths/showers.

- Change sanitary towels regularly to promote hygiene. Disposable sanitary towels can irritate the skin around some tears; you may wish to consider using non-disposable, washable towels made of more natural fibres such as cotton or linen if you experience discomfort.

- Some natural remedies have been traditionally used to ease discomfort, swelling and assist healing. This includes using 2-4 drops of lavender essential oil in a jug of water before pouring over the area or applying manuka honey to a pad before placing it in your underwear.

- Some home-made remedies include frozen pads (see here for instructions: http://mylittleme.com/homemade-postpartum-pads-for-soothing-and-healing/) which can be made ahead of time, and may be useful.

- Feeding your baby in reclining or side-lying positions can help ease the pressure in the area.

- Being aware of any signs and symptoms of concern, including offensive smells or worsening pain levels, and allowing your midwife to inspect the area if these occur, can help identify any problems with healing or signs of infection.

Post by Kelly, One to One Midwife

24 Jan

What is hypnobirthing?

I often get funny looks when I discuss the concept of hypnobirthing with women and their partners. 'Were not that type of people' is a common answer when I discuss it, however what does hypnobirthing really involve and what 'type' of people is it for?

As a One to One midwife I have been trained to be a hypnobirthing practitioner. Hypnobirthing is not about hypnotising you or making you do things you have no control over. It is in fact the complete opposite. Hypnobirthing encourages you to take control of your birth experience through educating you about what to expect in labour (physiology) as well as teaching you techniques to manage your experience. Hypnobirthing involves self-hypnosis or deep relaxation which is practiced prior to birth and enables you to feel calm and in control when the time comes to birth your baby. We also encourage women and their partners to consider the importance of protecting the birth environment, which includes careful consideration of birth partners as well as environmental factors such as lighting and noise.

We are socialised to believe that birth is a frightening experience with many risks involved. Although there is no denying that sometimes situations arise that can affect the risk involved in a pregnancy/birth there is also no denying that our bodies are designed to birth our babies. Research suggests that the level of control felt by a woman during her birth is the main factor involved in her satisfaction with the experience. Hypnobirthing aims to empower women and their partners to believe in their bodies ability and if necessary to have the confidence to question their care.

In my experience as a One to One midwife I have found that being in attendance at births where hypnobirthing is being used is truly inspiring. Women who believe in their abilities and allow their bodies to take over the process as nature intends rather than allowing their mind to control the process.

So to answer the question of what type of person is hypnobirthing for, I would say any woman who wishes to listen to her body and trust it to birth her baby in a calm relaxed environment.

If this is you then ask your One to One midwife for more information and about availability in your area for the free hypnobirthing courses ran by our team. I promise, you won't regret it!

Post by Emma Healey (One to One midwife & Hypnobirthing practitioner)

25 Sep

Perineal massage

Perineal massage is a technique which slowly and gently stretches the skin and tissues around the vagina and perineum. The perineum is the area between your vagina and rectum. Perineal massage helps reduce both the risk of tearing during birth and the need for an episiotomy (or “stitches”).

Perineal massage helps prepare you for the feelings of pressure and stretching that come as your baby’s head is born. Knowing what some of the sensations will be like can help you to relax and give birth instead of tensing up and fighting the sensations such as stinging, tingling or burning that you may feel as your baby’s head is born. Perineal massage can also encourage you to relax when you have a vaginal exam.

It is also helpful to learn relaxation techniques, information about your anatomy and what will happen during labour and birth.

CAUTIONS:

1.Avoid the urinary opening  to prevent urinary tract infections.

2.Do NOT do perineal massage if you have active herpes lesions, as you could spread the herpes infection to other areas.

General Hints:

The first few times It’s helpful to use a mirror to find the vagina and perineum and see what they look like.

If you feel tense, take a warm bath or use warm compresses on your perineum for 5 to 10 minutes.

If you have had an episiotomy with a previous birth, concentrate part of your massage on that area, Scar tissue isn’t as stretchy as the rest of your skin and needs extra attention.

The position in which you give birth can affect the likelihood of perineal tearing and the need for an episiotomy. Upright positions (sitting, squatting1 kneeling) or side-lying positions reduce the strain on the perineum. Lying on your back with feet up in stirrups makes an episiotomy almost inevitable.

After childbirth, tone up the stretched muscles in the vagina by continuing the pelvic floor (Kegel) exercises that you learned in childbirth preparation classes.

Directions:

1.Wash your hands

2 . Find a private, comfortable place and sit or lean back in a comfortable position.

 3 . Put a lubricant such as KY Jelly, cocoa also butter, vitamin E oil, or pure vegetable oil on your thumbs and around the perineum. You can also use your body’s own natural lubrication.

 4 . Place your thumbs about 1-1 1/2″ (3-4 cm) inside your vagina Press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling, or stinging sensation.

 5. Hold the pressure steady at that point with your thumbs for about 2 minutes until the area becomes a little numb and you don’t feel the tingling as much. 

 6. Keep pressing with your thumbs. Slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. Keep this up for 3-4 minutes. Remember to avoid the urinary opening.

7. As you massage, pull gently outwards (forwards) on the lower part of the vagina with your thumbs hooked inside. This helps stretch the skin as the baby’s head will stretch it during birth.

8. Do this massage once a day starting around the 34th week of pregnancy. After about a week you should notice an increase in flexibility and stretchiness.

 PARTNER MASSAGE:

General Hints:

You may use either your index fingers or your thumbs. Sometimes only one finger or thumb will fit into the vagina until the skin has become stretched.

Listen to your partner. It is her body. Be sensitive to what she wants you to do. Massage firmly but gently. She will tell you how much pressure to apply

Directions:

1.Wash your hands.

2.Put some lubricant on your fingers and on your partner’s perineum.

3.Place your fingers gently inside her vagina about 1-1½” (34 cm). Press down until she tells you it is beginning to sting and burn.

4.Hold the pressure there for about 2 minutes until she tells you it is getting numb.

5.Gently and slowly sweep your fingers from the center to the sides and back to the center again, pulling forward slightly as you massage. Give extra attention to any episiotomy scar. Remember to avoid the urinary opening.

6.Massage for about 3-4 minutes once a day.

Blog post by Amanda Wardle, One to One midwife
20 Mar

When a Bad Birth Haunts You

Birth Trauma is the term used to describe Post Traumatic Stress Disorder (PTSD) following childbirth. PTSD is a psychological response to a frightening or even life threatening experience where, within the context of birth, a woman may have felt danger to herself or her baby; loss of control and dignity; experienced hostile attitudes from the people around them or have felt their informed consent was not respected. Up to 10 000 women a year develop Birth Trauma and around 200,000 women develop symptoms of PTSD following birth.

Symptoms of PTSD stemming from birth trauma include:

• An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).
• A response of intense fear, helplessness or horror to that experience.
• The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
• Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
• Bad memories and the need to avoid any reminders of the trauma, will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time).

PTSD occurs as the mind attempts to make sense of traumatic events and this process is accompanied by anxiety and fear which are beyond the sufferers control and it is important to remember that this is not a sign of ‘weakness’ or a woman’s inability to cope. Birth Trauma is in the eye of the beholder and events that lead to such feelings will be different for each woman, however, research shows that certain experiences will put women at increased risk of PTSD such as:

• Lengthy labour or short and very painful labour
• Induction
• Poor pain relief
• Feelings of loss of control
• High levels of medical intervention
• Traumatic or emergency deliveries, e.g. emergency caesarean section
• Impersonal treatment or problems with the staff attitudes
• Not being listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth
• Birth of a damaged baby (a disability resulting from birth trauma)
• Baby’s stay in SCBU/NICU
• Poor postnatal care
• Previous trauma (for example, in childhood, with a previous birth or domestic violence)

PTSD is different from Postnatal Depression (PND) and requires different treatment therapies; however, the two conditions may overlap or be confused by health care providers.

http://www.bestdaily.co.uk/your-life/news/a555944/confusing-pnd-with-ptsd-and-why-we-need-to-listen-to-women-with-birth-trauma.html

If you feel you can identify with any of the above information or need further support and help please do not hesitate to discuss this further with your midwife, GP or health visitor. Below are some links for further support and information on Birth Trauma:

http://www.birthtraumaassociation.org.uk/what_is_trauma.htm

http://www.sheilakitzinger.com/birthcrisis.htm

http://www.solaceformothers.org/what_birth_trauma.html 

http://www.hypnotherapy-directory.org.uk/articles/ptsd.html

Information taken from http://www.birthtraumaassociation.org.uk/ 

Information provided by Rebecca Stephens, One to One Midwife


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