Midwifery and birth, NHS

Breathing , visualisation and psychoprophylaxis for labour and birth

Breathing through labour why is it beneficial ? Here’s how I explain it to women I meet
The Cervix
The cervix is an extension and integral part of the uterus – I recall learning about the cervix parrot fashion ‘finger like projection from the uterus’ . I uses the analogy of a ‘balloons tie’ for the cervix – a ‘balloons tie’ is holding in the air – the cervix is maintaining the integrity of the membranes – except it’s tightly closed not tied . The cervix is very vascular and has a mesh of nerves supplying it – hence it is very sensitive rich in blood supply .
A tightening / surge or contraction begins in the pacemaker(top) of the uterus situated close to the fundus and sends the signal down to push the baby’s presenting part onto the cervix which hopefully will cause it to efface and then dilate. This process is faster in subsequent pregnancies and may take hours in the first labour – no one really knows how long anyone’s labour will last-how fast-how slow – but breathing correctly can make a difference to the way it is approached and managed by you (by YOU I mean the woman) A lot of women I meet think they should feel pain high up in their abdomen and when I explain they are quite surprised but delighted.

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The pressure of the presenting part on the cervix leads to discomfort and this is due in part to an ischaemic (lack of oxygen) effect on the cervix – for example press hard on the palm of your hand with one finger then watch the skin go white then quickly return to a normal colour – this is capillary refill time – the time when the area is white is when the oxygen and blood supply is diminished . Now imagine that in context to the cervix which is a lot more vascular and nerve enriched than the hand . If a woman learns how to relax through pain and breathe deeply staying calm absolving stress the pain will be reduced . I’m not waffling, I talk and teach women this technique daily. I’ve had comments such as ” how did you do that ?” “Thank you I feel better ” – but in fact I’ve done nothing they have done it all themselves . A major part of breathing is the ‘art of visualisation’ the ability to close your eyes and see in your mind what is happening – this gives focus and assists the woman in the process . I say “if you are saying ‘I’m allowing myself to efface and dilate’ then you are believing more in the process – calmness mindfulness and self-belief will all assist and make the journey less arduous .
Effacement and Dilatation
How to describe dilatation and effacement? You cannot see this body mechanism so I thought of a polo-neck jumper – before it is pulled onto the presenting part(pp) the polo-neck (cervix) is un-effaced , as it is pulled onto the pp the polo-neck(cervix) is starting to efface . As the top of the polo-neck (cervix) reaches the pp dilatation begins

So here is an example of a surge/contraction/tightening

“Your cervical pressure is starting – stay calm focus on your calmness, the beauty of your unborn child and visualise your cervix being pressed and the oxygen you are breathing in rushing to replace the oxygen that is being pressed out – you are fantastic – believe in your body – breathe deep , allow yourself to dilate and relax “think of this like climbing a hill the happiness in your heart you feel as you reach the top (height of surge) then run down (surge reducing) this breaks the discomfort into manageable parts . All the time this is happening it is crucial that there is minimal disturbance 1.no-one entering or leaving room 2. Calm ‘generic’ music with no beat 3. Supporters who believe in the woman 3. Low lights – in other words tranquility – other mammals go to seek out quiet places where they cannot be disturbed and so we as midwives must make this happen for women. Interruptions stop the flow of oxytocin and can lead to an increase in intervention

This technique can be used throughout labour and also with the use of gas and air and is also helpful in a pool or even during a vaginal examination – but I feel that woman should be offered gas and air during examinations must be given the choice to do so.

A happy positive approach to labour and birth as well as intricate and detailed communication will give women strength . Knowledge of her body will give her the ability to entrust in her own body

My son has just asked to read this and said he’s found it interesting and can see that it would work. My inspiration for this blog comes from the women I meet every day that believe in themselves plus their supportive birth partners who take my words on board and continue to support their partners through labour- from the latent phase, right through to the birth of their wondrous children . Also thank you to the student midwives I work with who have encouraged me to write about the way I teach ‘breathing’

Breathe,Relax,Calm,Believe,Visualise and interrupt NOT!

Midwifery and birth, NHS

#skinToSkin my personal pilgrimage for babies and women

Today I’m up full of vim and vigour and decided it’s about time I explained my passion for skin to skin contact for babies. I was lucky enough to hear Dr Nils Bergman talk just over 6 years ago . I have always promoted skin to skin contact at birth as I am aware and fully conversant in The Ten Steps To Successful BreastFeeding by UNICEF . I am a fully fledged Key Trainer in BreastFeeding support – if anyone is having concerns or difficulties with BreastFeeding my first words are always skin to skin : )
I was however guilty of perhaps promoting skin to skin more for women who were keen to breastfeed and wonder now how many opportunities were missed because of my somewhat blinkered approach . As Sheena Byrom states regularly ” we are all learning ” (continually ) and if we don’t learn or stop learning we don’t develop, our gift to inspire is lost and the world will remain static – the quote by Gandhi “Be The Change You Wish To See In The World” helps me daily . I use the current tense as my journey is not a destination it is a pilgrimage to a nirvana (a state of blissful egolessness) where mothers will know all the benefits of skin to skin contact and be courageous enough to say they will be having skin to skin contact not “I’d like it” “if it’s possible” ” I’d like to try ” etc
Back to Dr Bergman – the moment you hear something that changes everything in your mind is described as a “lightbulb moment ” and that my friends is exactly what happened to me but first I had to test this theory and consolidate the evidence Nils had presented . Strangely enough within two days I was at work and with a woman who was having a Caesarean section for twins – the neonatal unit was closed. There were concerns about neonatal hypoglycaemia and hypothermia so I chatted to the mother about skin to skin contact and showed her the evidence that Nils had presented (women like to see facts so bear this in mind if you are ever trying to explain anything) she asked me to start skin to skin as soon as possible after her babies were born. The following is from my reflective piece that was written and sent to the North West Infant feeding coordinator

‘I facilitated skin to skin contact for both babies by fashioning a kangaroo system with a large soft cotton blanket . The blood sugars of the babies rose from an average of 6.1 to an average of 8.5 . The temperatures stayed normal and one of the twins that had some tachypnoea and grunting developed a normal respiratory pattern – the paediatrician had never seen this and was amazed . Both twins were prone but I never left the room so was able to continually observe their temperature respiration and heart rate . The woman had chosen to feed artificially – but it was incredible to see one twin crawling up her chest . She really enjoyed the experience and her partner and the twins grandmother took lots of photographs . I did not weigh the twins for a while and not until they were both settled this took less than one minute – skin to skin contact was just over 3 hours in total’

From that moment on I became a skin to skin addict and I was shouting from the rooftops about the benefits , the happiness it gave woman and stability it gave babies – so I started to look at skin to skin in different settings , promoting skin to skin regardless of type of feeding and networking with women staff and organisations.

Believe me when I say it’s not been easy and it won’t be – I’ve got myself into trouble at work for writing on a blank wall in theatre directly above the WHO checklist board “IS THE BABY IN SKIN TO SKIN” in large black letter with a huge heart on either side. I’m not saying you should all rush out and do that . What matters is raising the profile of skin to skin and with lots of support from my managers, colleagues and friends at work we are all making a difference within the NHS for babies to have a better start . All I’m saying is SO CAN YOU ! I put ‘skin to skin’ in tiny writing everywhere and I feel a bit like a skin to skin brainwasher staff say ‘ skin to skin’ to me all the time and I use it as a greeting or a way of saying good bye – it’s become my ‘high five’

Now onto twitter – TWITTER ! – initially I tweeted about my bears Billy & Bessie – which were bought to help a friend with severe depression. As most midwives know my ‘inner midwife’ tempted to peek at other midwifery related tweets and then I started thinking whether I could promote skin to skin globally by ‘harping on’ about it like I do at work and JennyTheM which was initially meant to mean Jenny the Mother – now means mother Midwife and Maven (with thanks to @Twidmife )

Twitter is the fastest way of seeing what’s happening in the world – whether it’s health , news , research , information and it’s got MASSIVE implications as it’s NOW ! I regularly go into work in the morning and tell a colleague about some news I’ve seen on twitter before I’ve even read a newspaper or heard the radio so please find your passion and tweet, enjoy, share and inspire

I’d especially like to say that I’ve gained courage from twitter and that the indomitable Sheena Byrom is always helping on my beautiful scenic pilgrimage to learn every day . Sheena has promoted the twitter buddy system and if you don’t follow her please do – also Florence Wilcock from Kingston hospital a truly family centred obstetrician who is spreading the skin to skin word within the team at her trust . The heads of midwifery that I follow and the student midwives who amaze me and are so 21st C modern kind and passionate , Anna Byrom at UCLAN for giving me a fantastic opportunity to present with music dance and laughter Jennifer Hicken (Great NorthMum) for inspiring me and believing in skin to skin and the people who are not NHS staff such as Annie McNamara, Ray Wilkins, Jo Platt and Duncan Richardson (for hedgehog info and moth phobia therapy) – you all keep me going make me smile and encourage skin to skin to ‘go viral ‘ ….. If there’s anyone I’ve missed please think this every single tweet I’ve read has affected me in a positive way and is helping all babies get #skinToSkin so tweet on tweeters : )

SKINToSKIN

JennyTheM

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Birth, Courage, Kindness, Midwifery and birth, Newborn, NHS, Nursing, Skin to skin contact, Women's rights

Skin to skin

This is my first blog day – blog sounds such a sad word it needs an injection of sunshine So here is my sunshine injection – all about Skin To Skin .
I want to inspire midwives to think carefully about the precious time before birth when the woman is approaching motherhood and the unborn child is about to become independent —- or is it?
Babies need their mothers love at birth they need to be held snuggled, have skin to skin and to feed – all those weeks inside and suddenly “POW”it’s lights, camera, Facebook,photos,text “what’s the weight?” Pressure to be back to normal for the woman (is there such a thing? Media pressure to run on a sandy beach holding a beautiful baby wearing white linen – this is not reality – reality is tiredness overwhelming love , sore perineum , visitors who don’t iron – midwives be honest – help the mother and child have so much skin to skin they overdose on love – talk about bed sharing honestly (Basis online is evidence based information about safe sleep for babies founded by Prof H Ball of Durham Uni is wonderful ) – remember we have become westernised – the cot , disposable nappies , and everything that goes against mammalian responses – let’s get back to nature and promote skin to skin for three hours – and let’s be real – let’s be human xxx #skinToSkin xxx