Category: Women’s rights

Antenatal education, Babies, Being busy as a midwife, Birth, Breastfeeding, Caesarean section, Change management, Children, Compassion, Courage, Helping others, Hospital, Human rights, Intra-operative care, Kindness, Labour and birth, Learning, Manual removal of the placenta, MatExp, Media, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, Newborn attachment, NHS, NHS Systems and processes, Obstetrics, Patient care, Post traumatic stress disorder, Postnatal care, Respect, Skin to skin contact, Surgery, Teaching, Women's health, Women's rights, Young mothers, Young women

The natural caesarean / the gentle caesarean 

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There’s a debate on Twitter this morning about the ‘natural caesarean’ as a term that promotes a positive experience of birth by caesarean. I don’t agree with the term and I think as health care professionals working in the area of birth we should ensure that every birth is a positive birth . Milli Hill started the The Positive Birth Movement  with this goal in mind (@birthpositive on Twitter ) 

Bearing this in mind I’d like to ask the following questions for you to consider and share with with your colleagues, family , friends , midwives and obstetricians . 
1. How many women who have an emergency caeserean and/or instrumental birth (forceps or ventouse) are given information in the antenatal period about the far reaching health and psychological benefits of skin to skin contact in this setting to both mother and baby ? 

2. Compare the above with how many women are given information about  skin to skin contact around normal birth ? 

3. Compare both to how many woman are informed that skin to skin is possible during manual removal of placenta and repair of any perineal trauma in the theatre setting ? 

4. Are women informed 

  • They can TELL midwives to defer the weighing of their newborn in order to enjoy the benefits of prolonged skin to skin contact 
  • That they should never be separated from their baby unless a clinical situation becomes apparent or they themselves choose not to have skin to skin contact despite being FULLY informed
  • That their baby could ‘self latch’ at the breast without any handling by staff and also correct its own acidosis and stabilise its own breathing because of skin to skin contact ? 
  • That skin to skin and early breastfeeding “Pronurturance ” is linked to a reduction in the incidence of  postpartum haemorrhage?  CLICK RIGHT HERE for the Pronurturance paper 
  • That if babies could talk they would choose skin to skin contact despite their birth environment 
  • That skin to skin contact is the building block for a persons social and psychological development 

The midwives and staff on social media who talk about caesarean are not promoters of it , they are giving women information about choice – so that if the operation (which is major surgery) does take place then these women are able to not only enjoy their birth experience but give their relationship with their baby the best possible start . 

I suppose it’s similar to the question “does having a teenage pregnancy strategy increase teenage pregnancy rates ?  (and I much prefer the term  “young women”to ‘teenage pregnancy’) 

Does having full information about your choices if you do go on to have a caeserean increase caesarean rates ? I don’t know the answer to either of these questions but I do know that the women I have assisted and sometimes fought for to have skin to skin contact with their newborns in different birth situations have all told me this 

 
-that they never realised the positive impact it had on them as a successful mother

To me this is enough .   
Thank you for reading 

With love , Jenny ❤️

I am also promoting #MatExp as a platform which enables and encourages discussion between women, families and health care professionals . 

Antenatal education, Babies, Birth, Breastfeeding, Caesarean section, Change management, Children, Compassion, Courage, Discharge from hospital, Helping others, Hospital, Human rights, Intra-operative care, Kindness, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, Newborn attachment, NHS Systems and processes, Obstetrics, Patient care, Postnatal care, Respect, Skin to skin contact, Surgery, Teaching, Women's rights, Young mothers

The Gentle Caesarean – Gentle with what ?

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Last year I was lucky enough to work in a general theatre for a week . I met a wonderful general surgeon and watched him perform bowel surgery . I noticed immediately how gentle and kind he was with the internal tissues and how calm and respectful he was not only towards the patient and his body , but also the staff in the operating theatre. All the staff admired this surgeon – you know when you can just tell ?  

I asked the surgeon afterwards about his technique and he said this

 “I always respect the tissue Jenny- tissues , blood vessels  , muscle and skin are part  of our human make up and being gentle with them means I am showing tissue respect and respect to the patient who is a fellow human . Being a gentle surgeon takes longer but believe me the outcomes are better and I know that there is less trauma , post-op bleeding , infection, pain and therefore happier patients and staff .”

Currently there is a lot in the news and emerging research around “The Gentle caesarean” and I am looking at this from a different angle  (and for those who know me well I don’t do acceptance well – I like to ask things so that others unable to ask might think differently ) so I am questioning what this term “Gentle Caesarean” actually means . Does Gentle Caesarean mean just the moment of birth or should it be right from the decision or choice of the woman to have an operative birth through to arriving home ? 

So for all those who work in the field of midwifery , obstetrics , intra-operative care, surgery , pain management -I would like you to watch a caesarean from start to finish and ask yourself “was that a gentle caesarean from that the moment that the woman arrived in theatre ? Was there gentleness with the woman’s feelings and choices ? Did the obstetrician, scrub midwife and others maintain gentleness towards the internal tissues and the to the baby? Was the transfer to the bed from the operating theatre table gentle ? Was privacy and dignity maintained at all times? 

Just because we have always done something a certain way does not mean that “the way” is always the best . 

I hope I spark someone to change practice and make “The gentle caesarean” standard across the NHS because then it will spread  globally – we must question on a  daily basis what we do and why we do it .
Thank you for reading , please leave feedback and / or share this blog with your colleagues 
With love and midwifery kindness , 

❤️Jenny❤️
Addendum today I am thrilled that The Times journalist Katie Gibbons has written an article about skin to skin contact at Caesarean  CLICK HERE to access or being the rebel that I am here’s a photo 😁

 

Bereavement, Courage, Grieving, Human rights, Kindness, Learning, Media, NHS, Post traumatic stress disorder, Respect, Women's rights

Aiming and succeeding – the journey of others  

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Today I’ve been reading a lot on the Internet and twitter about “The Secret” which is a dramatisation of real events that took place in Northern Ireland in 1991  -a tragedy that totally disrupted and still continues to affect the families of the victims . 

The courageous daughter of Lesley Howell (Lauren Bradford) tried her best to stop a programme going ahead . This programme has been advertised and aired on ITV as a “drama”. The drama is based on a tragic event that tore through the hearts of the families involved as well as their respective families and their friends . Lauren decided to make her own voice as well as others heard and wrote an outstanding, impactful letter to The Guardian about why she disagreed with the “drama” and the unforeseen effect of it being on aired on TV  would cause . The letter is  HERE. 

I feel that Lauren has written this letter to ROAR for her own mother  Lesley , a wonderful, strong, kind   and giving mother. Lesley’s voice was silenced by murder and so she cannot speak for herself about her life or how much her treasured children meant to her . Much more than this however Lauren has given other victims the chance to see that they too CAN  and MUST  speak out   – so in writing her wonderful letter she will have helped others to realise that their voices WILL  be heard . The media must no longer hold the power of ‘story telling the lives of others’  in order to make money or gain viewers or readers, they must realise that they don’t know the story so therefore it will never belong to them -it’s not their story after all is it?

Speaking out as a victim must be very difficult – which newspaper does a victim approach ?  Which TV company ? How does a victim ensure that their views enable others to empathise with their true story? Here’s how – be like Lauren   – write with truth and dignity in your heart. 

I am so immensely proud of Lauren  because through her words and thoughts she is actually helping others who may not be able to speak out to also have their voices heard . In addition to this Lauren is encouraging us all to think differently about how cases are reported and written about . How can it be right that a person can actually make money from someone else’s tragedy ? 

Thank you for reading and please leave your thoughts and comments on Lauren’s article . This will to help the media see there are two sides to every story .
❤️Jenny❤️

Hospital, NHS, NHS Systems and processes, Patient care, Women's rights

Tales of my aunt 

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I have been spending time with my auntie Anne (my dads sister)  . She’s over 100 years old and very strong willed , positive, agile, intelligent  and bright . As I’ve got older I always connected more with my mums sister and her husband Auntie Hilda and Uncle Bill) and they were always delighted to see me . Sadly my dear Uncle Bill  died last year after years of missing my late Auntie Hilda – I was heartbroken but I have happy memories of making wooden hearts with home on his jig saw machine and  long conversations on my mobile phone from his landline when he’d ring me and chat . He used to press coins into my children’s hands and say “buy yourself something , your mum needs money for food and your home” 

My younger sister clicked more with my Auntie Anne. Despite this I’ve always loved my Auntie Anne it’s just that we don’t realise the way that time passes . One day we are wondering what job to do and the next it’s time to think about a retirement plan . We miss seeing others and spending time with them whilst we are busy planning our futures . 

Back to my story – around  Easter time my Auntie had a fall and broke part of her pelvis (the superior rami to be exact) . I had to help so I offered my support to her daughter Judi and went to stay for a couple of nights so that Judi could go home  . 

Whilst I was there I learnt a lot about my late father and the tricks he’d get up to . It turns out he was a bit of a rebel . He kept mice in the coal shed and use to take two into school with him up his sleeve. At the age of eleven he cycled to Scotland with some friends because he’d always wanted to go there . I then learnt about other things – my dad Ralph worked  as a car mechanic and was badly electrocuted an accident which led to him developing a pleural effusion . He was sent to a Strinesdale Sanitorium as part of his recovery . I googled this place and found a diary which may gave me a small insight into his week’s spent there click HERE to read (bear in mind this was years before the NHS was established)

Anyway back to my auntie … 

My Auntie was sent home with greatly reduced mobility , the hospital in Manchester did not provide an ambulance and she had to crawl up hard concrete  steps to get to her flat .  Once inside she must have felt utter relief . She was with her daughter and my sister . My auntie told me that she hated being in hospital , that staff were not visible , that times had changed and she was glad to be home despite pain and worry about how she would recover more now because she was HOME.  The staff had even argued with her about her medication and what time she should take it . 

What strikes me about this true story is that my auntie does not complain lightly her mantra is and always has been “you’ve just got to get on with it ” . My Auntie is not soft , but she is human . I would like to know how discharge planning is ” we need your bed by 6pm and we can’t get hold of your daughter”

The decision to send my auntie home  was a rushed decision without discharge planning , thought for her amazing daughter and a total lack of insight . The discharge process should have started in collaboration with my Auntie as soon as she was admitted  – it didn’t . Strangely though I am glad for my auntie because she is recovering and she is safe . What about the other elderly people sent home like this with no family or friends to help them ?  My auntie is still waiting to see a physio , when my cousin rang  the GP the other day he said “I am NOT speaking  to YOU!” 

Let’s move onto to ‘carers’ . For six weeks my auntie is ‘entitled’ to support from carers in the enablement team . They assess DAILY whether my Auntie is improving . My argument with this approach is that there needs to be time for recovery to take place. This is a catch 22 position – here’s why 

1. Assessment cannot be during recovery – for example a midwife cannot assess the mobility of a woman immediately  post caesarean – it has to be done over time , using analgesia and when the woman is safe to mobilise . There must be clear information and evidence given to explain why post-op mobility is important but staged . Recovery is a human process and as each human is different so must each recovery be individualised according to age , pain , psychology , support and  love . 

2. Telling someone you are there to watch their progress is a watching role  so why not  call carers  who are employed to observe  and not give care “Watchers” 

3. The carers or the “watchers ” told me and my cousin ( we shared stories and reflected ) that by being there we were affecting their ability to assess my auntie . So I said to them “so do you think that to make your job easier either Judi or I or whoever is with my auntie is going to walk out and stay out so that  she can struggle the others hours that you don’t come ?”  My question is did the carers see our presence as an inconvenience to them not a benefit to my Auntie ?  

One particular carer came into my aunties flat did not say hello to my auntie and then said  “are WE getting dressed ?” To which my auntie replied “no WE are not ” ( I giggled ) 

Another day a carer came in hugged my auntie and they had a lovely conversation about eye conditions and I saw the light shine from her heart into my Aunties sparkling eyes . They connected and I could see and feel their mutual respect . A much nicer experience for my auntie than the day before when another carer striped my auntie off (apart from her knickers) and sat her on the loo and left her  to get on with a wash unaided . No cover or towel – I walked into to the bathroom covered my auntie and said “would you like me to wash your back  Auntie ?” Bear in mind I have never seen my auntie naked before. Was this carer respecting my aunties decency and dignity ? When the carer (watcher ) heard me she walked into the bathroom and said “I was just coming to do that ! SHE (meaning my auntie ) needs to get one of those back washers on a stick ” 
So I’m writing to the trust involved (in Manchester )  and I’m also adding that there must be some sort of regulation for carers . My aunties “carers and watchers” team  are not NHS – they are an agency with a contract -aye  there lies the rub . I must add that there ate two women in this team that  that stand out   head shoulders  and ❤️hearts❤️  above the rest . They told me that they don’t fit in because they love their job – now there’s food for thought . I’m glad the agency don’t allow theses two women to work together as that way they will reach more people with their kindness care and compassion . 

This blog is simply to help those involved in discharge planning for the elderly . It’s to help you  learn from patients and  relatives . Also it’s to try and identify where the communication and compassion  gaps are and how we  can do our best to try and fix them 
Thank you for reading 
❤️Jenny❤️

Antenatal education, Babies, Birth, Breastfeeding, Children, Courage, Helping others, Human rights, Kindness, Labour and birth, Midwifery and birth, New parents, Newborn, NHS Systems and processes, Patient care, Postnatal care, Skin to skin contact, Teaching, Women's rights, Young mothers, Young women

Memories of skin to skin contact 

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Those were the days weren’t they? Or were they ? 

This week I met up with a friend (pseudonym Niamh) who is a mother of four. She recounted to me each tender moment that each of her children was born . The last three were born by Caesarean section . “Did you hold them straightway?” I  asked .

Niamh replied “to be perfectly honest no – I held none of my children that were born by Caesarean section immediately in fact not for severel  hours ” Niamh then recounted to me the birth of her son – when he was about 6 hours old she had still not seen him properly and asked a midwife how he was doing – the midwife told her that he was fine but due to breathing problems he was in an incubator . SIX HOURS !! I want to add that no one had told her until she asked . 

If you are a midwife , an anaesthetist , an operating department practitioner or a theatre nurse. If you work in an operating theatre , or  if you teach those who do -I want you to think carefully about why we must all strive to keep mothers and babies together in the theatre setting . 

I know it’s becoming more common for skin to skin to happen and I realise that if it’s not happening that to fight the system and challenge separation is difficult but we must keep moving forwards  . The reason is simple – skin to skin makes babies happy and it makes mothers happy and feel like mothers . It reduces postnatal depression and admissions  to neonatal units , I’ve even seen it stabilise a mother’s parameters. There is new evidence emerging to show that in effect if Nimah had held her son straightaway he may not have been admitted to neonatal unit with breathing difficulties . 

Skin to skin is human nature – we must tell women why it’s important not just ask 

      “would you like skin to skin contact ?” 

We need to say

 “If you hold your baby immediately against your skin and WE will provide help and support . As a mother you can instantly reduce the chance of your baby producing  the stress hormone cortisol and this contact can and does have a positive nurturing effect that is invisible as it happening.

As health care professional we must practice evidence based medicine and skin to skin is evidence based . We are responsible for teaching why it matters – not just throwing it into a checklist, box ticking exercise . 

The ‘Niamh’ I am talking about is in her late 70s – her children ages range  from 38 to 48 years of age . Niamh recalls each birth , each separation  but even more than that she remembers her feelings of despair at wanting to see touch and smell her babies but feeling like she couldn’t ask . 

That to me puts it all into perspective .
If you’d like more evidence here is some of the latest publications 
Pronurturance 

http://www.sciencedirect.com/science/article/pii/S1871519215003558

Skin to skin at caesarean 

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003519.pub3/pdf/

http://onlinelibrary.wiley.com/doi/10.1111/mcn.12128/full 

I recommend you follow the following people and organisations so that you can converse  with those who are champions for skin to skin contact 

@JeniStevensS2S @CarolynHastie @HeartMummy @FWmaternitykhft @KathrynAshton1 @Natasha47 @Csectioninfocus @hannahdahlen @bloodtobaby @AAGBI 

Please take a look at my “skin to skin FB page”  for more resources 

https://www.facebook.com/Mother-Infant-contact-skin-to-skin-in-the-operating-theatre-setting-445225315630071/ 

Thank you for reading  #Keepgoing ❤️
With Love , Jenny ❤️

Babies, Birth, Courage, Kindness, Learning, Midwifery and birth, New parents, Newborn, NHS, Nursing, Patient care, Skin to skin contact, Women's rights

What Sparks Your Joy ?

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I enjoy making my home feel like a warm welcoming place to my family and to friends as well as to myself  . A calm happy home gives me the ability to relax as well as work hard. However, I do own some clutter and although my home is clean I have spots that need organising . So this week I bought the book “Spark Joy” by Marie Kondo- it is about keeping items in our homes that make us feel joyous and getting rid of things that do not . Whilst reading it I was suddenly struck to consider what “sparks my joy” in midwifery? What should I cherish love and hold onto ? 

I would keep public speaking/social media , being an advocate for women , MatExp and being a mentor. I would also extol the virtues of being a “radical” Here’s why 

Public speaking and Social Media 

I really didn’t realise this until I spoke at Uclan to the future midwives and then at the Breatfeeding Festival in Manchester. Truthful feedback is imperative to me as it enables me to develop and see myself through others eyes. My focuses as a speaker are to impart knowledge , learn myself , inspire others to leave feeling they can make a difference and change the way they seen themselves perhaps to consider presenting themselves . I have to feel a positive sense of connection with the audience and I make a solid effort to achieve this as  it’s definitely important to me that presenting is a two way process . I ask questions and I learn from the audience . As well as talking about my passion for midwifery I also openly admit that I can’t know everything . I like to involve humor and also poetry – I feel so happy when others laugh and learn with me . The other reason I love attending conferences is that I network with other midwives and people who have a shared goal in making the NHS and especially maternity services even better . I see one of my key roles as tweeting at a conference to share the experience and agenda with the global midwifery network . I have made many real friends through twitter and I will continue to reiterate Eric Qualmans words “We don’t have a choice on whether we DO social media , the question is how well we DO it” I am privileged to have just written a section in an article with Teresa Chinn MBE about this topic . Teresa’s website HERE and she is the founder of We Communities which has changed the digital face of nursing midwifery medical and allied health professionals on line . Click HERE to find out more . I never in a million years realised that Twitter would connect me with such a community of compassionate and driven people . Social media is a vehicle that helps us to share information, learn and enable . This immeasurable crucial part of the infrastructure of global healthcare gave me the courage to become a blogging midwife and connect with the MatExp team but even more reinvigorated my passion to learn even more about midwifery the NHS , leadership , kindness  and start to cherish my own long hidden rebelliousness . Through THE SCHOOL FOR HEALTH AND CARE RADICALS I e found it’s ok to be radical and that change takes time and committment – if you want to learn more join the next cohort which starry this February – you will not look back (click HERE ) 

Being a mentor 

My other joy is being a mentor I love to ask future midwives how I can facilitate their learning and yet learn from them . I see myself as a radical mentor I talk about, teach and observe for compassionate care , courage and good communication. When working with students of any discipline  I feel it’s so important to hear their voice and also to be honest to them about obstacles they may encounter to prepare them for their future roles . I am a truthful mentor and it’s just so crucial that the first meeting is positive. My goal is to melt their fear or apprehension as soon as we meet  – to let them know that I am a teacher, a learner  and also that I am helping them on a journey . I do like to give spontaneous teaching sessions and find it hard to contain my excitement when future midwives tell me about  new research or publication. Mentoring also includes being a role model to peers , newly qualified midwives and reaching out to give others  help, inspiration and guidance face to face as well as through social media. I have several key mentors in my life and career who assist me through coaching and reflection which in turn aids my development as a mentor .  I love to hear news from colleagues and students as well as sharing with them new things I’ve read via social media , recommend blogs or books  to read and upcoming conferences . 

An advocate for women 

I will have been a midwife for 23 years this June. I see myself as constantly evolving and realise that I will never reach my destination – I don’t want to though I want to keep growing each day . By having this approach I  hope that I am open to women’s families and colleagues voices .I extol the long term and short term virtues and benefits of skin to skin contact at any opportunity .  Being a midwife means being a strong communicator and embracing oneself as an ambassador for global women . It’s about being current and modern despite age or experience – this ethos should apply to all who work in the NHS . Choice and consent should be embedded into our role as advocates . Cotinuity of carer must be a priority plus a positive communicative relationship  between the midwives  and  women all embedded into what we do just as much as a building needs a roof , windows , a door and warmth .  

MatExp 

Mat Exp is all about maternity experience . It’s a change platform where anyone can participate , discuss and suggest new ways to assess , plan, implement and receive care – putting the family first in Maternity services . MatExp is also about staff who are involved in this specialty and how we can improve their experiences too. This is why I adore it – everyone has an equal and valid voice – there is no hierarchy and ideas are constantly flowing . MatExp HQ exists in a virtual digital sense – it’s everywhere and a testament to the true power of social media . Due to MatExp I’ve learnt more about PostTraumatic Stress Disorder due to birth trauma which can affect men as well as women . I understand  more about the feelings of families when their babies have been stillborn or died after birth . I have been able to connect with women, families, health professionals and radicals to  spread the word about why collaboration works because we are actually doing it  . I have also met the most amazing people from all walks of life and feel I have connected with them in making a difference . Just search #MatExp on twitter or take a look at the website HERE to read about who is already involved and how you can get involved . 

So now you know what sparks joy in me- I’d like you to visualise Change as a form of  decluttering – it’s not necessarily forgetting about the old – but it’s making sure it’s archived so that we can look back as well as forwards and see why it’s so important to keep moving shifting and changing. Let’s make NHS care “Spark Joy” in the people that use it and the ones who work in it .

As a form of reflection think of four things that Spark Joy for you within your own work and life and write about them . 

Thank you for reading 

Jenny ❤️ 

Ps To my grown up children , my family and friends you also spark joy within me and you are and always will be in my heart – thank you ❤️

Being busy as a midwife, Birth, Courage, Discharge from hospital, Kindness, Learning, Midwifery and birth, Newborn, NHS, Patient care, Postnatal care, Skin to skin contact, Teaching, UK Blog Awards 2016, Women's rights

The UK Blog Awards 

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I have entered this years UK Blog Awards in the Health Category to raise the public profile of midwifery in a positive light . 

Compassion is a crucial part of any midwife’s role and I find that blogging helps me to open the window of my midwifery soul through the written word.

It’s crucial that women and families have access to midwifery support now and in the future . Social media is a great way to connect to others and also to learn , inspire and lead. 

You can vote for me BY CLICKING HERE

Thank you for your ongoing support and for reading and sharing my blog . 

With love from Jenny 💛 

 

Birth, Breastfeeding, Courage, Kindness, Learning, Midwifery and birth, New parents, Newborn, NHS, Postnatal care, Teaching, Women's rights

Seeing the whole picture 

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Each person we meet and care for  has their own story. 

As health care workers we must keep striving to tune into those that we care for – humility is needed and an ability to connect. Digital technology is a huge part of record keeping so it’s essential to realise that ‘CARE’ is not simply a tick box exercise but in fact a multi dimensional emotional process that may not have a solid beginning or ending . 

Trying to step into another humans story is a spiritual art form   – the way that we listen as well as the way we speak can have an immense impact on what a person imparts. A brusque manner can inhibit a connection, prevent sharing of valuable information, foster a disjointed attitude and is totally destructive to the priceless treasure of two way communication and empathy . A kind compassionate manner however, can help a person to open up and share information about themselves by helping them to relax and feel a sense of trust towards the other person. There are some people who have this off to a fine art and if you know such a person watch and learn from them you will gain so much. 

As midwives If we exude warmth and kindness we will send out positive connections – this will improve the oxytocin response and give women a feel good factor about themselves which will facilitate positive pregnancy ,labour, birth and breastfeeding . We underestimate the power we have to influence women and their ability to nurture themselves and their young . 

The midwife in the operating theatre setting who sends out signals of peace and calm by helping the woman to have skin to skin contact with her newborn is instrumental to the health of the world – she is brave and courageous and more than that she epitomises “human-kindness” itself.

The midwife who is able to read signals from the new father and help him to open up and see his strengths and yet embrace his own vulnerability is an asset to the family unit. 

The midwife who acts as an advocate for the same sex couple who want to avoid induction yet at the same time stay safe helps them to feel like they have been empowered and respected yet also like it’s their own choice . 

These are all examples of the wonderful work that midwives do and it’s time to celebrate all the admirable midwifery role models out there that inspire so many . 

Let’s all keep doing what we do well and try to improve a little each day . Let’s not stay still or remain where we are but let’s keep moving forwards for the mothers the fathers and the children of the universe. The world needs positive role models in midwifery some are visible some are hidden so seek them out shine a light on them and give them a loud cheer . 

Thankyou for reading – please be kind 

Jenny ❤️

Babies, Birth, Breastfeeding, Discharge from hospital, Kindness, Learning, Midwifery and birth, New parents, NHS, Postnatal care, Skin to skin contact, Teaching, Women's rights

Transfer from hospital to Community care – planning in maternity services 

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There is so much written about discharge planning for Care of the Elderly / Unscheduled care / patients requiring rehabilitation .

Currently there are extra pressures on maternity services and I have set out my objectives as to why I want to discuss postnatal discharge planning below 

1.To highlight beacons of positivity 

2.To inspire discussion 

3. To make discharge planning an intrinsic part of the admission process 

4. To identity where a same day transfer should not be promoted

5. To make the actual ‘time of discharge’ a governance issue  

6. Share good practice and eliminate bad practice 

7. Raise the profile of effective discharge planning in maternity services 

I have learnt from others and by listening to families how the NHS could streamline the discharge process I’m certain that this would make a positive impact on staff time , families understanding , effective communication , reduce complaints and develop a well rounded understanding of the  discharge process. 

Going home with a newborn is seen as an easy and smooth process so my blog will try to help parents as well as midwives and maternity workers to see that this is not always the case. 

The best time to be discharged home is in the morning , however the pressure on postnatal wards is immense and they have one of the fastest turnovers in the NHS . So often we hear of women and newborn being sent home at ridiculous hours and  HERE is an article about this in Mother and Baby 

So how can we streamline the discharge process ? 

A. Find out if the family have transport home 

B. Start the discharge paperwork by checking address and phone number are correct 

C. Ensure medication to take home is requested as soon as possible 

D. Promote and explain why prolonged skin to skin contact will ensure not only breastfeeding success but also maternal and newborn wellbeing and that continued skin to skin contact is important as well as talking to the newborn and feeling calm (it’s crucial to discuss co-sleeping and I usually direct parents to ISISSLEEP as well as explaining – I’m not going to go into depth about this now, but  I do with parents.  

E. Ask about support at home – visitors who come and help are very valuable and aid recovery and coping . At the same time it’s important that the new family have some time alone in order to gain confidence in being new parents and learning to recognise various cues that their newborn makes .  

F. Go through thoroughly signs and symptoms of illness for mother and baby and mention sepsis – any infection caught early improves the outcome. 

G. Ensure all levels of midwifery staff are competent to discharge women and babies home – in busy times when there are pressures on the service this will facilitate an “all hands on deck” situation 

H. Employ a discharge facilitator who can assist clinical staff to organise the paper trail 

I. Have a generic checklist to refer to primarily so that women and families can see what the process entails and secondly so that staff do not miss any of the steps involved and this will avoid mistakes and maintain communication at all levels .  

J. The first point of contact in regard to any queries should always be the labour ward and / or community midwife . Midwives are responsible for postnatal care up to 6 weeks post birth – I am proud to say that when women present at labour wards they are seen quickly – a walk in centre or a triage service are not equipped to deal with postnatal care – midwives are . 

Explanation, discussion , allowing time and two way communication are all integral to a successful discharge process . I like to tell families that the discharge is in effect a transfer of care to the community midwifery team and also what to expect from the visit. Midwives do not expect families to be up , dressed and ready with the house perfect – they are visiting to see how families  are feeling and coping . To assess if the baby is feeding well and to give support . 

Rushing the process because of pressure has no value and affects communication in a negative manner – it’s so valuable to discuss why discharging takes time at antenatal group and have information on discharge at clinic appointments . 

Ideas such as group work on the postnatal ward to increase questions and save time are being developed in various NHS trusts and discharge guidelines should be updated regularly to match the process. 

Talking about safe regular analgesia and how to take medication will improve recovery , reduce infection , help mobility and be key to reducing venous thromboembolism . Perineal pain is real – it hurts – but in the first day it may not be as bad until the woman arrives home and starts to question her pain threshold . Pain management is part of postnatal care and can make the difference between good recovery and feeling awful for days . 

Perinatal mental health care is gradually improving and it takes skill and experience for midwives to recognise it if the woman is reluctant to disclose . Continuity of carer and knowing ones midwife makes talking about postnatal depression and anxiety easier – but we still have a lot of work to do . HERE The Guardian highlights perinatal anxiety . Post Traumatic Stress Disorder is now a recognised illness caused by trauma around birth – communication and compassion at birth can reduce this and I recently received a letter from a woman telling me that skin to skin contact helped her to cope during an emergency situation – so there’s something to consider .  I am proud to know Emma Sasaru who has PTSD and courageously BLOGS  in order to help other mothers to recognise the signs and how to seek help . 

As the midwife completing the discharge YOUR responsibility is also to ensure the baby is feeding  and that you have observed a feed and given the mother support. Talking about maintaining milk supply and support groups as well as how to recognise that the baby is thriving must be discussed . It’s just as important to explain and know the family understands how to make up milk if the baby is not being breastfed.

 The neonatal examination is not a future prediction of health it just says the baby is fine at the moment it is done . Any signs like continuing sleepiness, a very quiet baby , poor muscle tone and slow weight gain might be indicators  of poor health – mothers usually have an instinct about these things so listen well and get the baby seen by a paediatrician – don’t manage the baby at home without senior input . 

Finally time of discharge is an issue – do families reall want to go home at 23.00 or 3am ? It’s a personal choice but CHOICE it must remain there is no place for sending women and newborns home in the middle of the night – does it happen in any other department? I have never heard of children being sent home in the night or elderly patients so why should we accept it for women or maternity services?  If you have concerns that families are bring sent home at inappropriate times there is action you can take – escalate it to your line manager , fill out an incident form , discuss at your team meeting and raise with your governance lead. Ask other units what they do and be pro-active . 

The main point I want to get across is that discharge from hospital is a complex process . It is much more effective when there is two way communication between midwives / obstetricians and families . Talking about going home must start as soon as the admission process starts. Discharging someone home must be a high quality , thorough , kind and efficient task. It must also be individualised and embody compassionate care . Use your skills in effective discharge and teach them to future midwives – it’s important to share good practice. 

I hope I have raised your interest  in discharge planning . I appreciate and value all feedback and understand there may be some points I have missed . My main aim is to promote thought , discussion and change . 

❤️Thankyou for reading  

Love Jenny ❤️

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

Who interrupts skin to skin contact? 

Follow @JennyTheM

When a newborn is gently placed into skin to skin at birth with its mother complex intricate physiological and psychological processes begin. As midwives we must be mindful of the next stage and fight back the strange urge (that seems to be a part of our midwifery culture) to move the baby . 

Evidence shows that  if the baby is moved after any period of time before the first breastfeed then the whole process must begin again, it’s like restarting a stop watch. 

Patience and a detailed awareness about the physiology of breast feeding , mammalian responses ,the effects of intervention and why an early breastfeed will be an indicator of long term breast feeding success must be reinforced . The continually evolving fresh bank of ever expanding new research is gaining momentum. Emerging facts  about  ‘skin to skin contact’ such as it’s ability to reduce postpartum haemorrhage (this article can be read HERE ) , also the positive effect that skin to skin has on long term maternal mental health should be making us all sit up and think . If newborns experience skin to skin contact for long periods of time both at and post birth in combination with positive parenting the newborn will grow into a child and then an adult with an increased ability to socialise,  be compassionate and be kind. 

One thing stands like stone to me though and it is this 

Which mammal do we know that puts its trust in another mammal and then allows that other mammal  to take control of and/or disrupt the connection between the mother and the newborn ? 

I have had so many emails and messages from mothers, fathers  , future midwives , midwives , doctors ,peer support workers, friends  and family about ‘who owns the baby ?’ I feel the time has come for us all to challenge the constraints put upon us and to encourage women to shout out … 

 “this is my baby – I grew this baby I nurtured this child – I am the birth mother and I will not let anyone move my baby without my consent – I am part of the dyad and we work together – we two are one ” 

I would like to see more written about skin to skin wishes for birth if the situation becomes medicalised or complex – so that the other parent can have skin to skin contact . I would also like  other health care professionals  to consider whether they should be holding a baby without a reason. A family must also be fully informed and educated on the unseen detrimental effects of separation on the birth mother and the newborn . 

Can we honestly say that we inform future parents that if their newborn is moved out of skin to skin contact too soon that it will affect their baby’s ability to breastfeed and the mothers ability to lactate  ? Do we inform women that skin to skin contact gives a feel good factor ? 

Have we made birth a production line business ? For example how many times have you heard “is the woman in ‘Astra birth room’ ready for transfer to postnatal ward yet ?” Without the woman herself being asked ? Do we have a  constraint around time of birth to time of transfer to the ward ? Is it fair and equal that woman who give birth within a Midwifery Led Unit / Birth Centre can stay in the room they are in until they go home ? Whereas women who give birth on a labour ward are moved and then even separated from their partner in some hospitals ? 

These are all my thoughts and I am writing to provoke questions in my own practice as well as trying to help families and midwives . My skin to skin journey is an ongoing one and any feedback will be valued and appreciated 

Thank you for reading 

❤️Jenny ❤️