Your pregnancy, your midwife, your choice

Information

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

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

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)

20 Oct

Nub Theory

What is nub theory?

Is it true about the angle of the dangle?

Can you really find out your babies sex at 12 weeks?

Any best guess would be only slightly better than 50/50 and would have to be confirmed again at the anomaly scan at around 20 weeks. The honest truth is that it is very difficult for a sonographer to see clearly all the structures at dating scan and the genitalia of a fetus at this stage is very unclear and looks very very similar for both male and female foetuses.

'The correct visualization of any fetal part depends on many factors such as fetal position, amount of amniotic fluid and thickness of the abdominal wall. Establishing gender can sometimes be very difficult.'

The theory is as follows:

The following images are from 12-14 weeks.

Image 1: Supposed male fetus in development. With the male fetus, the genital tubercle usually creates an angle of greater than 30° with the lower part of the spine.

Image 2: Supposed female fetus in early development. In the female fetuses, the genital tubercle protrudes in the same direction as the lower portion of the spine with an angle of less than 30° relative to the backbone.

Various studies have supposedly been done to test this theory.

Studies have been conducted in Brazil, London (2studies) and Israel. Out of a total of 1619 pregnancies; gender was assigned and confirmed in 1424.

The results when combined together found that genre was accurately predicted at:

11 weeks 68%
12 weeks 88%
13 weeks 94%
14 weeks 98%

From: http://baby2see.com/gender/study_ultrasound.html#Brazil

I must highlight that I have searched one of the biggest online journal forums on the internet (which has never failed me when it comes to medical research) and I couldn't find any of these supposed studies!!

You must also remember ladies that not all sonographers will be trained to recognise and capture images like the ones here. This is not something we usually look at so early on.

I personally and professionally am not convinced. You may believe what ever you like though and I would LOVE to see the original articles and research if anyone has any links to them then please post them below.

Post by Sally Barnes, One to One Midwife

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
15 Apr

Top five tips for preconception health

As Easter approaches we may be thinking about what that means to us or even telling the Easter story to our children.

Easter is celebrated in many ways such as with the Easter bunny, Easter eggs and fluffy chicks. This is to represent new life and new beginnings.

This may be a time when you’re considering starting that new life by trying for a baby.

Did you know that care before your pregnant is as important as when you’re pregnant?

A healthy mum + healthy dad = healthy baby

Ideally preconception care should be started at least three months prior to conceiving. In fact all women should be thinking about their health even if they are not considering starting a family. One reason is that about half of the pregnancies are unplanned.

Five things to boost your preconception health

• Take 400 micrograms of folic acid every day. This will lower your risk of some birth defects such as spina bifida. 
• Aim for an optimal BMI. A person’s BMI can affect their fertility status along with their health. 
• Stop smoking and drinking alcohol. Smoking can affect the women’s sexual and reproductive health as well as their long term health and that of their children. Women who smoke are twice more likely to be infertile or take longer to conceive than those who do not. In men, smoking affects the sperm morphology can cause low sperm count
• If you have a medical condition, be sure it is under control. Some conditions that can affect pregnancy or be affected by it include asthma, diabetes, oral health, obesity, or epilepsy.
• Seek advice if you’re taking any over-the-counter or prescribed medicines. These include dietary or herbal supplements. Be sure your vaccinations are up to date.

Preconception care can improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy baby.

Post by Cheryl Tomlinson, 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

08 Oct

How to make bath times an enjoyable experience

How to make bath times an enjoyable experience

Bath time is one of the most enjoyable experiences to have with your baby, and if you plan, your baby will love their bath times. I would recommend that you ensure the room you plan to bath your baby in is warm and that you have everything you need ready in advance, including – your bath filled with warm water, a warm towel, toiletries, clean nappy, and clothes.

To ensure the water used is at the correct temperature (36-38 oC), put cold water in the bath first, and then hot. This reduces the chance of scalds. Test the water with your elbow (as hands can bear very high temperatures) before you put your baby in. It should feel comfortably warm. Your baby will enjoy bath time more if she is not hungry or overtired.

You can either bath your baby in their own baby bath tub or co-bath with your baby in your family bath. Either way try these simple steps to make it a pleasant experience.

Once you are ready;

• Undress your baby on a safe surface.
• Wrap your baby in a warm towel, keeping her head exposed.
• Cradle your baby firmly under your arm- supporting her head.
• Gently wash your baby’s head over the bath by using your free hand to cup the water and apply the water using your hand. Using a pea size amount of mild baby shampoo, gently massage it through and rinse. Be careful not to get the soap/shampoo in your baby's eyes - stinging eyes can put babies off bath time. • Place your baby back on the surface and gently pat dry her hair.
• Lower your baby feet first into the water, supporting her head and neck at all times.
If you choose to co-bath- rest your baby against your chest keeping their head exposed and out of the water and their body submerged in the warm water- just be sure the water is at the safe temperature for them. 
• With your free hand, gently splash water over your baby's body.
• Keep talking to your baby for reassurance and to let her know she is safe.
• When you have finished, take your baby out, wrap her in a warm towel and then apply a nappy and dress her. 
Please Note- It is not safe to leave a baby or toddler alone in water, not even for a second. 
Newborns do not require daily baths because they do not get dirty, and their skin is very delicate. Bathing once a week is more than enough for the first few months to protect your baby’s skin from becoming dry. As your baby gets older however, bath time can become part of your evening routine. Evidence-based guidelines recommend bathing a baby with warm water only for the first two-four weeks of life and the use of creams and lotions for dry skin should be avoided (Walker et al, 2005) 
Top and tailing is an alternative to bathing for your very young baby. This is a quick way to cleanse your baby and you can do this once a day.
• Undress your baby but leave the nappy on.
• Wipe your baby's face, neck and ears with some damp cotton wool you have wet in a bowl of warm water, and dry with cotton wool or soft warm towel.
• Cleanse your baby’s eyes using a dampened cotton wool ball dipped in cooled down boiled water-wipe from the inner to the outer eye, and discard the cotton wool-repeat of the other side with a fresh piece of cotton wool.
• Wipe your baby's hands and under her arms in the same way.
• With a newborn, wash any discharge from the cord stump with a dampened cotton wool ball dipped in cooled down boiled water.
• Remove her nappy.
• Wash her bottom and genitals well (wipe girls from front to back to avoid spreading germs from the bottom to the vagina) and dry.
• Put on a clean nappy, and replace your baby's clothes.

Reference Walker, L., Downe, S., Gomez, L. 2005. Skin care in the well term newborn; two systematic reviews. Birth. 32 (3); 224-228.

29 Aug

Why choose a home birth?

WHY CHOOSE A HOME BIRTH?

It is shown to be as safe as hospital birth for low risk women and women feel calmer, more relaxed, and in control because they are in their own familiar surroundings, therefore needing less pain relief. They can move around at will, and birth where they feel most comfortable.

ENVIRONMENT?

Women can prepare their own birth place. They can 'nest' and have their birthing space quiet, with low lighting, scented candles and favourite music playing. Food and drinks can be taken as needed and mum can rest and sleep at will.

HOW?

Women can birth in whatever position they wish, wherever they feel most comfortable. In a birthing Pool, bedroom, on a settee? On all fours, squatting or supported by their birth partner. They can utilise Hypnobirthing techniques, engaging in positive visualisation and breathing techniques.

WHO?

At home women can choose who they would like to support them with their birth. Other family and children may be around, One to One midwives will be on hand for guidance and encouragement.

During the pregnancy, women and their birth partners can 'plan' with their One to One midwife where and how they give birth. This will ensure a more positive birth experience, where mum is in complete control, secure in the knowledge that she is in a safe hands.

If you were wondering about home birth, never considered it, or want to know more, speak to your One to One midwife who will be happy to discuss it with you. Home Birth Groups are also available, speak to your midwife for more information or message directly from our website: http://www.onetoonemidwives.org/enquiries

Post by: Kim Sefia, One to One Midwife

17 Aug

Would you consume your placenta?

Would you consume your placenta?

The placenta is the organ which functions to feed your baby with oxygen and nutrients via the umbilical cord until they are born. After birthing the baby the placenta is also passed and routinely disposed of as clinical waste. However, the placenta is believed to have healing and nutritional qualities and therefore some women choose to consume their placenta following birth to reap these benefits. Two common ways of consuming your placenta are by blending it raw into a smoothie or having it made into capsules to be taken following the birth.

Research claims that the benefits include:

Improved energy levels
Reduced bleeding post birth
Increased milk production

For more information and some recipes see the Independent Placenta Encapsulation Network website http://placentanetwork.com/

Have you or would you consume your placenta?


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