As I sit here writing this blog, I am surrounded by paraphernalia in preparation for ‘The Baby Show’ where we are exhibiting over the next few days. One of the reasons we chose to do this (aside from marketing our brilliant postnatal packages), is that we wanted to reach more expectant parents to try and help them understand and plan for the huge transition that will occur once the baby has arrived, and to encourage them to really think about what to expect in the early days! Having a new baby is just about one of the hardest thing you will ever do; caring for a baby 24/7, recovering from childbirth and dealing with lack of sleep often adds up to an intense and sometimes overwhelming period of time.  At The Baby Show, we have been invited to speak each day about taking care of yourself in the early days, and these are our top 5 tips that we will be sharing:

Delegate household chores BEFORE you have the baby. Arrange a cleaner, organise on-line food groceries, book a dog-walker. Think about what you can get someone else to do so you don’t have to.

Sit comfortably: cesarean or perineal stitches can be sore and tender after the birth of a baby. Trying using incontinence knickers in the first few days. Much more comfy than thick maternity pads and sit high over the cesarean scar.

Sleep, rest, sleep and rest a little more. You’ll be told this a lot.  But it makes a huge difference to long term recovery if you make sure you rest.  You can save being ‘super mum’ for a later date.

Take your time: recovering from childbirth and understanding your new baby doesn’t need to be rushed.  It takes around 4-6 weeks to physically recover and learn the skill of breastfeeding.

Eat well: feeding a baby makes you supre hungry (you’ll need an extra 500 calories a day).  Fill your fresser with pre-made food and have plenty of nutritious snacks on hand, such as dates, apples, cheese, vegetable crisps and hummus. Try making these ‘goodness flapjacks’ – you’ll love them!

 

If you’re heading to the baby show, come and visit us at stand D5.  We look forward to seeing you!

When I started my midwifery training, I remember our tutor going around the class and having us introduce ourselves. Each person said a little about why they came into midwifery – and several of my colleagues (and later friends) talked passionately about their own birth experiences, good or bad, which led them to exploring midwifery as a career. I remember feeling that the mums in the group already had such a head start on the rest of us – and that I would always be a bit ‘lacking’ as a midwife until I had actually been through pregnancy and birthed a baby myself. As I progressed through my training and became a more confident student and then a qualified midwife, this feeling never entirely left me, and the question from pregnant and labouring women would often be asked: ‘do you have children yourself?’. So, when my husband and I found out that I was pregnant back in February this year I was very pleased to be finally adding the accolade of ‘mother’ to my CV!

In those very early weeks before any real pregnancy symptoms appeared, I honestly felt that as a midwife I was entirely prepared for the first trimester of pregnancy. I knew it was likely to be tough, and I had some trepidation about nausea and sickness (particularly as my sister had hyperemesis throughout both of her pregnancies) – but I assumed that my midwifery experience would at least mean that nothing the first trimester could throw at me would take me by surprise. And of course, as you’ve probably already guessed – it did! Completely! The nausea was constant and severe from 6 weeks of pregnancy, and I also started experiencing debilitating migraines which I had never had before being pregnant. There were many days when my husband came home from work to find me in the same position he had left me that morning. During this period, as I’m sure all pregnant women do, I tried absolutely EVERYTHING to try and find some relief (see photo above for just a small selection of my remedies!). Some things worked for me and some things didn’t, but one thing that did work wonders for me was magnesium…

Magnesium

Angela and I have long known the benefits of supplementing with magnesium in pregnancy, and often recommend Epsom salts baths to our clients. The majority of the population (pregnant or not) are deficient in magnesium, and in pregnancy our bodies find it even more difficult to absorb this mineral. I had assumed that as I was taking a wholefood pregnancy vitamin containing magnesium that this couldn’t be my problem, but after speaking to a very knowledgable midwifery colleague I learnt that our bodies can’t absorb magnesium in tablet format. So, I purchased some dissolvable powdered magnesium (I used Mag365 and bought it from Amazon for speed of delivery – I was desperate!) and started taking it that evening after 3 days of severe headaches. Within 24 hours I was completely headache-free! Magnesium deficiency can cause all sorts of symptoms in pregnancy, including headaches, insomnia, cramp and oedema (swelling) and so taking a supplement such as this, massaging magnesium oil into the skin or soaking in regular Epsom salts baths can bring much relief to pregnant women.

Diet

Despite having a very good diet pre-pregnancy (little sugar, no wheat, lots of vegetables, no processed foods etc) I found that to get through the first trimester I was eating everything I knew to be terrible for me! White bread, sugar in all forms from jelly tots to snickers bars to ice cream, lots of cheese and dairy and very little else. Nutrition is something I am very interested in and which we spend a lot of time discussing with our clients, and I was quite ashamed of the contents of my food cupboard and fridge for many weeks. However – I truly believe that you do whatever you can to survive those first few weeks, and that feeling guilty about it isn’t helpful at all. I had said this to clients having rough first trimesters in the past, but it is only now that I truly understand the reality! Now that I am feeling less nauseous I will be taking some of my own advice and incorporating protein into all of my meals and snacks, and cutting back on the sugar. Interestingly I already feel less inclined towards sugary things, it is amazing how our bodies tell us what is best for them if we listen hard enough.

My final thought on the first trimester would be to apologise to any clients who I haven’t been as sympathetic to as I should have been! The terms ‘morning sickness’ and ‘tiredness’ are so common when discussing the first trimester that it is easy to underestimate the impact they have on your daily life. I am just now starting to feel a bit more like a normal human being and hoping that the blooming will happen very soon!

Tami x

This week has been a very special week for me as an IM, and I was very honoured and privileged to receive third place in the BJM Community Midwife of the Year awards.

It was a spectacular evening hosted by the British Journal of Midwifery and a real highlight in the midwifery year; a time when midwives from all arenas can be acknowledged for all the hard work they do – and a wonderful opportunity to wash of the placenta and booby milk, get dressed up, and let our hair down!

Being an independent midwife is hard work; there is an awful lot that goes on behind the scenes and being on call 24/7 is not always easy.  It is however incredibly rewarding, and after heading up to collect my certificate on Monday night, I was reminded of some of the really hard times over the past few years when IMUK worked hard to retain independent midwifery and the right for women to choose.  During that time, I made a ‘Week in the Life’ video to use at an IMUK open day to highlight the work we do and the way we do it.  I am really pleased to share this video with you now:

I love being a midwife (mostly) and do feel very privileged to work in this way.  I am not sure that being on-call will be right for me forever, and I do grow weary of it at times.  However, I think that probably applies to many of the different midwifery avenues that are out there: any job that gives of yourself can lead to burn out and fatigue – which is why it is so important that we look after ourselves – and are looked after (Jeremy Hunt take note).

So thank you BJM for my award, thank you women for sharing your lives with me, and thank you to everyone who supported the campaign to save IM’s and kept us going!

Angela x

I have two expectations when a student comes to spend some time with me:

1. That they have read Ina May
2. That they are prepared to learn how to use a Pinard (if they are not already practised)

When we think of all the technological advancements that have been made in pregnancy and childbirth, it is often assumed that the beautiful Pinard Trumpet is better placed way back in the ‘olden times’, but this little piece of midwifery equipment is (and should be) a staple part of midwifery practise – where-ever that is taking place.

Firstly, lets look at what National Guidance says about the Pinard: intermittent auscultation is the national recommendation for the ‘low-risk’ (that’s another blog in itself) woman in labour.  In these guidelines it recommends the use of a Pinard or a doppler (sonic-aid).  It also states that when there is a concern with a low base-rate foetal heart on continuous monitoring, it is important to ascertain that it is not the maternal heart that is being recorded.  The Pinard isessential in that clinical scenario is you can not pick-up the maternal hear beat when using one.  So, the expectation is that a midwife should know how to use a Pinard.

Secondly, let us think about the routine use of a doppler (sonic-aid) to auscultate the baby’s heart rate.  The little sonic-aid is a wondrous invention; it enables midwives to hear that rhythmical heart rate, reassuring that all is well, and enables parents to hear their baby’s heart from very early in pregnancy.  I always find it completely heart-melting the first time parents hear that sound and they are full of bare emotion.  BUT, when we use a doppler, we send a high-wave frequency through the uterus that resonates with the baby (again, that’s another blog post).  Although National Guidance no longer recommends routine auscultation at an antenatal appointment, many mothers find this a reassuring and exciting element of their care.

Around 2 years ago, as I reflected on my birth statistics, I realised that I had a relatively high number of ‘compound presentation’ births (this is where the baby is born with it’s hands’ up by its head).  Whilst this is not usually a problem, it can sometimes make birth a little longer or potentially cause more perineal trauma for mum.  I pondered on this for a while, and recalled a very wise, older midwife once saying that she felt we had more compound presentations since the introduction of routine sonic-aid use, and perhaps the baby’s were “‘covering their ears from the high frequency sound”.  So I started my own little trial and I no longer use the sonic-aid in the last trimester or pregnancy: instead I show the women my little Pinard (they love it!) and use a foetoscope (see picture) so that they too can listen to their baby.  And yes, in that time I have had NO babies with hands up by their heads.  Maybe a coincidence?  But one I am not tempted to test!

How to use a Pinard
You can only really use a Pinard or fetoscope successfully from around 28 weeks of pregnancy – before this the baby is just too small and you have to place the Pinard directly over the baby’s heart or shoulder, so you need to be able to palpate where the baby is lying.  Antenatally, its relatively easy to use once you’ve become skilled at palpation and ‘listening’, so as a student midwife this is the best time to hone your skills!  It is usually easier to start with a plastic Pinard and progress to a wooden one.  The ARM sell beautiful beech Pinards.

Using a pinard in labour can however be a little trickier -especially if the woman is planning to use water in labour. The expectation will be for the woman to lift her bump in and out of the water which can be very disruptive to the flow of her labour!  A water-proof sonic aid is a God-send as you can easily monitor her baby’s well-being and work around her by reaching down into the pool and under her bump as unobtrusively as possible.

Sara Wickham has written a lovely explanation on how to use a Pinard (saves me re-writing it!) and Kay Hardie, from Kent Independent Midwives has made an excellent you-tube video on how to use a Pinard.  Read and watch to learn – and then practice, practice practice until you are confident and able to use one!

The Pinard Trumpet may be an ‘old fashioned’ peice of equipment, but its place is just as relevant in 21st century midwifery as it ever was.  What do you think?

I have struggled to write this particular post for the past week or so; do I reference, don’t I reference. Am I trying to be the ‘expert’?  Is this formal, informal.  Argh – round and round I go!  Until a colleague reminded me this is a BLOG post, meaning it’s an informal piece of my opinion (see disclaimer thingy) and breathe……..

I can still remember the first Vaginal Examination (VE) I performed as a student midwife.  I remember two things mainly:

1. I had no idea what on earth I was feeling!
2. That this was a very invasive procedure

Many units have a 4-hour guideline for VEs to assess the progress of labour; this routine assessment has no real evidence to support it and is still of unproven value in routine midwifery care, despite being recommended by NICE (it is important to acknowledge, that NICE states women should beoffered a VE).  VE’s can be a very helpful tool in understanding a labour when perhaps midwifery intervention may support the woman in keeping her labour normal, when clarity around labour progress is appropriate, and / or if it will affect the plan of care.  When used as the marker for progress in labour only, VEs can cloud the midwives understanding of what is happening in the woman’s birth story and cause the woman to doubt her own body.

The art of Midwifery is the ‘big picture’, and it is through many different signs that a midwife may recognise where a woman is in her labour.  This awareness is not ‘taught’, but learnt: learnt from the women as you observe undisturbed birth, learnt from sitting and quietly absorbing the behaviours unfolding in front of you, and learnt from not starting from a place of ‘knowing best’.  As a result of this, the thoughts below are not a ‘check list’ of progress in labour, simply prompts to help you consider the physiology of what may be unfolding before you.  Remember also that all women are different, and every woman and birth can unfold in a way that is unique for them.

Let us consider then, alternative ways of recognising a labour that is progressing:

How low can you go?
When I was a student midwife, I heard the wonderful Jane Evans speak on Breech birth.  In her talk, she described how women get ‘closer the the ground’ as their labour progressed.  In labour, as those powerful surges increase in intensity, the woman finds it harder to be upright and conserves her energy by moving into positions that bring her down – usually into the all fours, or leaning over a sofa etc.  As a guide, the closer she is to the ground and needs to stay ‘grounded’, the further along in her labour she is likely to be.

Those wonderful noises
Experienced midwives can often tell where a women is in a labour from those lovely noises she omits; Liz Nightingale wrote an excellent article in Midirs on noises in labour which is well worth getting your hands on. Women, under the influence of Oxytocin in labour, start to withdraw into themselves.  Talking and conversation dwindles (and so too should birth workers!), but the woman will naturally start to moan and groan through those surges; those noises come from deep within her and she has little control over them.

The ‘purple’ line
If you google this term you will find lots of excellent blogs reflecting on this phenomena, pictures on what you may see and so forth.  My favourite post is inBirth Without Fear which is beautifully written: just read that for a great explanation on the purple line.  I love the purple line; once you recognise it you can’t fail to notice it.  Just wish bottoms came with a little gauge – you know, when it’s this height the cervix is x-cms etc!

Sense of humour failure
When the woman is no longer smiling, then we are in serious business (except for those women who are having serene, orgasmic births – they smile a lot).  Humour can really help a woman in labour as it can ease tension.  If you follow her guide however, the more serious she becomes the less she may appreciate wise-crack jokes from her supporters, and the more likely her labour is advancing well.

It’s all a bit sticky down here
Around 8-9 cms, women will discharge a sticky, blood-stained mucousy plug as the cervix really opens. Yay!  Even better still, as the cervix becomes fully open, the waters will spontaneously release if they have not done so already.  There is NO NEED to do an ARM if a women is 9 cms and membranes are intact (and yes I have seen midwives do this, because otherwise how will the baby get out?).

Cold Feet
As the uterus continues to work beautifully, the blood circulation will move more and more towards to uterus: this is why women get cold feet as labour progresses.  A German midwife (when I was a student) also taught me that the heat will move ‘up the woman’s’ legs.  At around 5 cms, the heat will start from just above her knees, 8 cms the thighs feel cold, at 9cms, only a small amount of heat is left at the top of her thighs.  We used to have guessing games by gently placing a hand on the woman’s thighs to see ‘where she was’.  It doesn’t always work, but is gentle and non-invasive.  Use the back of your hand to gently asses the coolness of the legs.

Pushing on through
Why, oh why, oh why on earth do some midwives feel the need to ‘confirm’ the onset of second stage with a VE?  Really?  As a woman moves into second stage, she will start to make grunting / expulsive noises.  These will intensify as the baby moves further down, triggering further expulsive urges.  The woman’s body will start to ‘open’ as the rhombus lifts.  The purple line will be highly visible and prominent.  She will probably poop.  All of this will happen either quickly (as with the foetal ejection reflex), or for the vast majority of women, s-l-o-w-l-y!  Women can tell when they are ‘moving’ their baby and will often remark they can feel the baby moving down.  If after a period of time of strong expulsive urges, there are no external signs of descent, then a VE may be appropriate.  That time depends on the whole clinical picture.  And no, 10 minutes is not long enough.

There are many other ways of recognising progress in labour without the use of VEs (and please do share them); these are the ones I use to help me recognise that labour is progressing without needing me to ‘do’ anything other then keep the mother and baby safe and hold the space for the birth.  Observing the woman in a non-invasive way (i.e. not staring at her and‘drinking tea intelligently‘) normally enables the midwife to sense if something is not ‘quite’ right and provide the appropriate care to help the mother birth her baby as she needs to.  And this is usually herself.

Angela x