Your pregnancy, your midwife, your choice

Information

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

01 Apr

Monitoring fetal heart rate in labour during a home birth

Your midwife has a choice of ways to listen to your baby's heart during labour. The most common is via a sonicaid, which is a handheld Doppler and you may be familiar with this method, as your midwife may have used this to monitor the baby throughout your antenatal period. Most sonicaids can also be used under water and so if you are planning a home birth with a pool, you won’t need to worry about keeping moving in order for your midwife to listen to the baby, she can work around you!

The benefits of the hand held Doppler are that you are able to hear your baby's heartbeat as well as your midwife, however some women prefer not to have a sonicaid to listen to their baby, so instead your midwife can use a Pinards stethoscope. This is a trumpet shaped, wooden, plastic or metal item and is placed onto your abdomen with the widest part of the Pinards and the flat part with a hole in the centre is where your midwife will place her ear in order to listen to the heartbeat. This is one of the oldest methods used to listen to the fetal heart. Your midwife should be trained to use this as sometimes sonicaids can break down!

There is another device, which is sometimes used and this is called a fetoscope. It is a little like the stethoscope your midwife uses to check your blood pressure but has an extra attachment shaped like a bar which your midwife places against her forehead and rests this against your abdomen and then listens to the fetal heart via the stethoscope.

The normal heart rate for a baby is between 120 bpm and 160 bpm, although there can be variations such as accelerations above 160 bpm or decelerations below 120 bpm which are normal.

In labour the midwives will listen to the fetal heart rate every 15 minutes whilst you are in established labour, for at least 1 minute after a surge/contraction. This is so we can determine how baby is coping with the labour and most babies cope very well. Sometimes babies become a little distressed and your midwife then needs to evaluate the situation. This will also depend on other factors, such as how far along in labour you are, position of baby, etc. This may present as the fetal heart having decelerations, especially if they are unprovoked, e.g. not caused by cord compression or could present as a Fetal tachycardia where the heart rate is above 160 bpm for a prolonged length of time. Your midwife is trained to evaluate the situation and to act as necessary. This may mean a trip into hospital to evaluate further.

In the last part of your labour, the expulsion phase where baby is being born, midwives listen to the fetal heart rate every 5 minutes, again to evaluate how baby is coping.

Some women like to use their own hand held Doppler’s to listen to the heartbeat themselves, but please be aware that you may not hear the true heartbeat as sometimes your own maternal pulse can be picked up and also you can sometimes hear the cord pulsating rather than the heartbeat.

If you are concerned at all about your baby please contact your midwife.

Post by Debbie Hibbs, One to One Midwife


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