Category: Young mothers

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Midwives – Defenders of women’s rights @JennyTheM ©️ #IDM2019

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5.5.19 is international day of the Midwife and my blog is dedicated to all Midwives who have made a difference by defending a woman from any unnecessary intervention – be that anytime related to pregnancy 🤰🏾 antenatally , during any kind of birth or postnatally.

I’ve decided to share three stories which are true experiences written by midwives about defending women. One of the stories is mine but I won’t say which one .

As clinical midwives we are seen as equal members of the huge maternity wheel alongside women and their families, managers, obstetricians, future midwives , maternity support workers and many more – although in reality there is a hierarchy that many within our own discipline and other disciplines are striving to challenge and change .

The truth in plain sight is that just one member of the team is not engaged or equally involved (including the woman) then the intricate workings of the mechanism will be disrupted.

Women and families = get to know your midwife/midwives . Ask questions , be curious. Read books that are informative, recommended and that explain your bodies and your babies abilities with balance and clarity . Try the Positive Birth book by Milli Hill Click HERE to see on Amazon (founder of The Positive Birth Movement) .

Prepare yourself as much as you can. Don’t leave any stone of knowledge or information unturned . Join a positive birth group Click here to find out more . Be aware that midwives are defenders of women – talk to other women and find the midwife that helps you to believe in yourself . You’ll know when you’ve found her – don’t settle for second best. I believe women should rock the boat of maternity services like pregnancy pirates. Try reconnecting with midwife from a previous birth if you have other children – it’s evidence that continuity pf carer will reduce your chance of interventions so ask to see the same midwife at your appointments. Look at the birth statistics of your local units and choose wisely – ❤️ The Which birth guide is a good resource although might need updating Click HERE to view

Managers = be insightful of how staffing levels and skill mix will impact positively or negatively on birth outcomes – when you arrive to help us in our hour of need ask not what we can do but show us what you can do to improve our shift . Stay curious ❤️

Obstetricians = be mindful of the physiology of the female form and how your positive or negative behaviour will impact on the delicate balance of all hormones involved in playing out the birth process . Watch midwives working see them as equals . Stay curious ❤️.

Midwives = be aware of why you are a midwife. Embrace your role as not to

“do to”

but to

“be with”

to defend,to stand up for ,to support, to strengthen and to keep safe. Unite the team with your passion for all births❤️. Stay curious

Maternity support workers I am thankful for you all – you do support ❤️- your gratitude towards the midwives that make the toast and tea for the family and ensure rooms are left clean before transferring women from them . (we do ask other midwives to follow our suit) as we know you always have work to do within the scenes and behind them – running the operating theatre, birth-room turnaround time , restocking , clinical work, bringing the team together , being aware of all areas . The camaraderie and team work you display so strongly within your discipline is a benchmark for us all . Stay curious

❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️

Three stories of defending

Read on reader ….

Story one

The elective premature Caesarean birth – a courageous Midwife

All eyes upon me , the baby is only 34 weeks old . The mother’s instinct to hold her newborn is tangible I hear her breath . The paediatric team stand around the resuscitaire , prepped , ready, waiting and impatient. Something inside me tells me “give the baby to the mother , give the baby to the mother” After delayed cord clamping I cocoon the newborn in a warm towel without touching and within seconds I’m helping the mother with her first embrace. Time stands still. I monitor the baby closely but without words for colour , breathing , heart rate (with my stethoscope) tone and reaction , a saturation monitor on the baby’s right hand (pre-ductal) reassures me. All is good . I offer to take photos of mum dad and baby, mum and baby , baby’s hands touching mum , many photographic variations evolve in so little time . I look across at the paediatrician- she knows me, trusts me – she smiles at me and nods mouthing “it’s ok” . Five or more minutes have passed – mum knows it’s time . Dad carries his newborn to be seen by the team . Mum is crying not with sadness but with joy that hers was the first skin to touch her newborns , then her partners – this is how every new beginning of life should be – we Midwives must step aside but wait in the wings ready to prompt or assist- our silent presence is reassuring to the family ❤️

It was all worth the fear – afterwards I hug the paediatrician and say “thank you for trusting me ” the mother scrolls through her photos in disbelief that her only ever precious child started its journey against her skin – I am a defender ❤️

Story Two

The “Failed” Induction challenging a decision

“Can I help ?” I offered “Oh great” replied the ward Midwife “we are so busy!! Can you go with the consultant to see the woman who’s Induction didn’t work ?”

I’d been sent from labour ward to help on the antenatal area . The consultant was counselling an elderly primigravida ( over 45 years old) . The woman “Joy” (false name) was being told that two attempts at induction and due to her age that a caesarean would be for the best . I was sent to get the consent sheets . I’d just completed the AQUA shared decision making course and I was keen to put what I’d learnt into practice.

The time on the clock was 16.55 so bear that in mind .

What happened next was that the consent forms were handed to the woman after the risk of Caesarean was explained . The woman dutifully signed the consent forms and the consultant left the department. Something inside me told me this didn’t feel right . My instinct and experience made me go back to the woman and her partner. I asked them if they were okay with everything. In fact I went as far as saying “are you okay about your Caesarean birth?” They both voiced their concerns but felt they haven’t been given a choice. I wanted to discuss further so I went to the phone and rang the consultant to return . The phone call did not go well -the consultant was quite irked that I’d phoned told me to check the clock and to ring the consultant on call.

I rang the on call consultant who came and discussed further the choices the woman had with her and her partner . She opted for an attempt at labour following artificial rupture of her membranes which would all take place on the labour ward .

To cut a long story short the woman progressed to 5cm dilatation and remained there . She was very pleased with the fact that she’d experienced labour and been listened to . Her caesarean birth was a positive unhurried experience.

A few weeks later I came face to face with the first consultant one my day off – I’d come into work to attend a two hour study session . The consultant openly criticised me in front of a new senior registrar who I’d never met before – belittled springs to mind . “Thank you for overruling my decision to plan a Caesarean without labour” were the words. I stated clearly that the best way to clarify the situation was to determine how the woman felt – “are you invited to the naming ceremony of the baby ?” I asked “no” was the consultant’s curt reply – “well here’s my invite” I said (by coincidence I’d found it in the staff mail box that day) . The consultant went quiet and walked away . I am a defender ❤️

Story Three

Rebalancing the birth hormones

I met Nasrit about one hour into my shift in the morning. (name changed) . The community midwives has brought her in because her labour had slowed then stopped. Nasrit was having her third child, she lived with anxiety and panic attacks which were inherited from her childhood . My opinion was that her fear had disrupted her birth hormones – I discussed this with her – she held my hand tightly . I went to the midwives station and put Nasrit’s name on the board – as I did I could hear staff chipping in “does she need an ARM?” “Get the syntocinon running when the Reg arrives ” “is she actually labouring ?”

I pretended not to hear the comments . I was going to go back to Nasrit, Nasrit’s partner and Nasrit’s mother . My plan was to try and get Nasrit into a birthing state of mind . I wanted to make her at home. In giving her possession of her room I made her space – no lights , quiet , no interruptions and a haven for her birth . I keep a set of battery powered fairy lights in my locker and I’m trained to use aromatherapy. My key goals were to make sure I had everything in the room that Nasrit needed and nothing in the room that anyone else needed -there were going to be no interruptions. I used a blend of lavender and frankincense in hot water as a room infusion. I explained to Nasrit how aromatherapy would work. I then turned off all the lights and switched on the fairy lights . As an equal I explained to Nasrit and her family how relaxing can help oxytocin and that anxiety can hinder by producing cortisol and adrenaline . Nasrit was with me . I sat and held her hand (at her request ) we all waited without talking . I reiterated that there was no pressure . It took about 15 minutes for Nasrits heart rate to drop from 96 to 68 – she was breathing more calmly .

Over the next two hours Nasrit’s labour recommenced and soon she was holding her newborn skin to skin . I never left the room .

All was well

I am a defender ❤️

Summary

So the reason for my blog is for you to try and reflect on your own practice as a midwife and find those times when you were a defender. Look to see when you recognise fellow defenders through their words and actions . Try not to ask “does this feel right for the woman ? ” “is the woman’s face reflecting agreement or disagreement ”

Stay curious and keep defending

❤️We are defenders❤️

#IDM2019

Post script dedication I’m dedicating this blog to all midwives in hardship – whether physically, emotionally or financially. The Cavell Trust is a charity that helps nurses , health care assistants , maternity support workers and midwives Click HERE for more information

Thank you for reading my blog .

Yours in midwifery love

JennyTheM ❤️

Stay curious

and like Professor Lesley Page (@Humanisingbirth on Twitter) be the leader of the dance ❤️❤️

Antenatal education, Babies, Being a mum, Birth, Children, Compassion, Hospital, Human rights, Labour , birth, Labour and birth, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, Postnatal care, Respect, Skin to skin contact, soeaking out, Student Midwives, Women's rights, Young mothers, Young women, zero separation

Newborn babies – photographed without their parents – my bugbear

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Everyone who knows me knows that I promote , research and present about SkinToSkin contact . I know exactly why it matters to mothers , fathers and babies .

Just recently I’ve noticed an advert for an upcoming ITV series “Delivering Babies ” in which Emma Willis stars as a auxiliary nurse assisting on a maternity unit – the profile photo shows a picture of Emma holding someone else’s baby without any of the parents in the photograph – this is what prompted me to write this blog .

One particular bugbear I have is seeing a baby on a photograph with a health care professional without the mother or father being included in the picture .

I have discussed this with many future and new parents and explained that they are the guardians of the newborn – protecting it from unnecessary exposure to anything . At most schools there is a social media policy which prevents the posting of children on social media sites . However the same rules don’t seem to apply for newborn babies.

I see many programmes about pregnancy, labour , birth and the postnatal on TV which I choose to critique. Some I have given up watching through exasperation that the baby is not seem as a child of someone .

I have had heated debates with maternity managers , future midwives , midwives , maternity support workers about why a baby should not be photographed without any of its parents . I ask them this question “if you had a baby would you want it’s photo to be on someone else’s social media account , mobile phone or perhaps even framed on a sideboard in someone else’s home that’s not even related to you ?”

Just google “Midwife” and numerous photos will pop up of midwives holding someone else’s baby . There’s even one from Call The Midwife – time to rethink why these photos exist and consider the human rights of the newborn ?

Below are two collages I made following a google search – who are these babies and were the parents asked for full consent and counselled thoroughly about the fact that their babies would appear on internet searches ?

My other concern is WHO takes the photo ? If it’s on the parents phone and given to the midwife as a gift does that make it ok . What is consent ? Eg “could I have consent to use this photograph of me holding your baby to post on social media / put into a frame at home , look back on and wonder who that baby belonged to in 20 years time ” OR “could I have a photo of you as a family with me in the background which I will treasure and treat with respect , I will not post it on social media and it will remain a midwifery memory for me of meeting you ?”

In taking photos we must consider

Is it necessary ?

Please leave your comments below

Yours in midwifery love

@JennyTheM

Against the odds, Babies, Being a mum, Being busy as a midwife, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS Systems and processes, Obstetrics, Postnatal care, Respect, Skin to skin contact, Student Midwives, Women's health, Women's rights, Working from the heart, Young mothers, Young women

Postnatal transfer to the ward from labour ward – my thoughts

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A DM (Direct Message) on Twitter is a message you receive from someone that no one else can see – apart from the people included in the message.

In the past four weeks I have received 7 DMs from a mixture of midwives , future midwives and women all with the same subject matter . This subject is mainly about ‘who decides when a woman is transferred from the room she gave birth in to the postnatal ward’ This seems to be a hot topic at the moment as the variation in time from birth to transfer is huge – especially when comparing Caesarean birth transfers to other birth transfers (and it might surprise you to know that the variation in birth to transfer time to the ward for women who have Caesarean birth is also vast – some units care for these women on the labour ward until their spinal has worn off , some units transfer to ward within a short time in recovery which leads me to question that support with breastfeeding must be patchy).

Just the other week at Salford University Midwifery Society Conference ‘Transforming Birth’ click HERE for a summary of the day – I asked a question to the audience “are you, as future midwives pressured to move women to the postnatal ward (after they have birthed their babies) faster than the women themselves would like or you as a future autonomous practitioner would like ?” The result was that over 80% said YES.

Do we as Midwives consider our own autonomy enough when we are working ? In order to give the woman a sense of feeling cared for and nurtured individualised, compassionate, holistic midwifery is paramount . Each woman is different- some may prefer a rapid transfer , others may not . Some women may need extra support to establish breastfeeding or be debriefed post birth or some women may want to rest in a quiet place with minimal noise before they are moved to the ward . If a birth takes place in a birth centre which doesn’t focus on time , women will stay in the same room post birth until their discharge home.

In the NHS patient care sadly revolves around the concept of time . If a patient is not seen , admitted or discharged within a four hour time frame (see photo below ) it is considered a “breach”

Certain procedures have a standard time frame in which so many can be done – this is how operating theatre lists are generated and how the NHS deals with waiting lists .

However birth is and must be a positive experience – even though it has coding costs and some births are planned to the day -we must give women more than they expect – stand up for them , be their advocates. Challenging the system is one of the ways we can make change happen – if we all accept each day “this is the way we do this” we cannot be developing our roles or our practice to improve woman centred care . I’m not saying it’s easy but I want you to imagine what care you would want for your sisters and your daughters ? Then give the women THIS care – I am in the NHS as I nursed my own mother until her death at home – I see the connection between care at birth and care at death . I have been a nurse to the dying and that experience has impacted on the care I give to women in a most human way .

Whatever care you give , whether you transfer a woman in your fastest time or not is all rather irrelevant when you focus on the bigger picture – YOU are responsible for the care you provide , or you don’t provide -if you tell a student to do something that is YOUR responsibility and I suggest referring to this NMC publication which I look at each day The NMC CODE . If advice or suggestions are not kind , caring and have a direct clash with your duty of care , if a more senior Midwife tells you to do something this should be documented in the notes and be evidence based, kind and resonate with your trust guidelines plus the NMC code.

Sometimes we are stretched short staffed , rushed and under pressure but at no point should this be the woman’s problem.

So the next time you are preparing a woman for transfer to a ward just think

  • Have I given her & her partner enough time alone with their newborn
  • Have I helped initiate feeding
  • Am I rushing her ?
  • Do I feel under pressure ?

Then if necessary give her some more time – and when you arrive on the ward give continuity of care to the woman and her newborn by transferring in SkinToSkin contact , admitting them both to the ward environment yourself , taking and recording observations , checking the woman’s pad and fundus ,getting the woman a drink and this will also help your colleagues on the ward immensely.

❤️Be a holistic professional caring Midwife ❤️

Thank you to the student of Salford University and those who DM’d me on Twitter – you inspired this blog

Thank you for reading

Yours in midwifery love

JennyTheM

❤️

Anaesthetics, Antenatal education, Anxiety, Being busy as a midwife, Birth, Change management, Communication, Compassion, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Newborn, NHS, NHS Systems and processes, Obstetrics, Paediatrics, Psychology, PTSD, Respect, Women's health, Women's rights, Young mothers, Young women

Loss of control – a reason for fear of birth ? 

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When any of us are admitted to hospital we lose control . We are unable to get a hot drink when we want one , eat what we want when we want to ,take simple pain relief , go to the toilet , sleep as well as we would at home , get up in the night or stay in bed longer . We are also unable to control what we hear , what we see . We lose our safe place of home and being surrounded by friends and family – it feels lonely and alien to us . This doesn’t mean that we are not able to adapt to new situations it’s just that more than a few things change and this throws a curveball towards us .  The fear we feel is because we feel we are handing ourselves and our bodies , our routines and home comforts over to others, they are dismissed  – this has quite a destabilising effect on our psyche . 

A key part of NICE CG190 guidelines for care in labour encourages midwives to set the scene for women. The section I am going to focus on is COMMUNICATION – which is part of 1.2 Care throughout labour (click on the following numbers to be taken to the site)  CG190 

I have copied and pasted the exact words and written the key words in CAPITALS below to help highlight their impact – does it make you think about them differently ? 

COMMUNICATION 

1.2.1 Treat ALL women in labour with RESPECT . Ensure that the woman is in CONTROL of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To FACILITATE this, ESTABLISH a RAPPORT with the woman, ASK her about her WANTS  and EXPECTATIONS for labour, and be AWARE of the importance of TONE and DEMEANOUR , and of the ACTUAL WORDS used. Use this information to SUPPORT and GUIDE her through her labour.

1.2.2 To ESTABLISH communication with the woman:

GREET the woman with a SMILE and a personal WELCOME, establish her LANGUAGE NEEDS , INTRODUCE yourself   “#HelloMyNameIs”

explain your ROLE in her CARE .
Maintain a CALM and CONFIDENT approach so that your demeanour REASSURES the woman that all is going well.

KNOCK and WAIT before entering the WOMAN’S ROOM , respecting it as her PERSONAL SPACE , and ask others to do the same.

ASK how the woman is FEELING and whether there is anything in particular she is WORRIED about.
If the woman has a written BIRTH PLAN , READ  and DISCUSS it with her.

ASSESS the woman’s KNOWLEDGE of strategies for coping with pain –PROVIDE  BALANCED INFORMATION to find out which available approaches are ACCEPTABLE to her.

ENCOURAGE the woman to ADAPT to the environment to meet her INDIVIDUAL needs.
Ask her PERMISSION before all PROCEDURES and OBSERVATIONS, FOCUSING  on the WOMAN  rather than the TECHNOLOGY or the DOCUMENTATION .

SHOW the woman and her birth companion(s) how to summon HELP and REASSURE her that she may do so WHENEVER  and as OFTEN  as SHE NEEDS to. When LEAVING  the ROOM, LET her know when you WILL return.

INVOLVE the woman in any HANDOVER OF CARE  to another professional, EITHER when ADDITIONAL EXPERTISE has been brought in or at THE END OF THE SHIFT. 

Every person who cares for (no matter how short a time ) a woman in labour should follow this guidance and I feel there should be posters up on maternity units in all languages which emphasise that this will happen . 

There are many barriers to communication and one that most midwives, student midwives , maternity health care assistants , obstetricians and anaesthetists agree on is that time, pressure and NHS systems restricts our practice. I want to have laminated cards that go with the analgesia cards to explain why kindness and compassion will also help ease women’s pain . Fear is a huge factor in the perception of pain and if we try to reduce fear we might help reduce not only  pain but also anxiety and then by this we will gain trust and build on positive care. 

As the  midwifery workforce we must start to say to ourselves “how would I feel ? ” another question which is used on the Nye Bevan leadership module is this …. 

Lets keep sharing our ideas and thoughts and if you have any more relating to CG190 – tweet using #CG190 or why not write a blog or design a poster ? 
Thank you for reading and please leave comments , I always value them and they help me to reflect and grow . 


Yours in midwifery love 

Jenny ❤️

Babies, Birth, Breastfeeding, Caesarean section, Children, Compassion, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour and birth, Learning, MatExp, Midwifery, Motherhood, New parents, Newborn, Newborn attachment, NHS, Obstetrics, Patient care, Skin to skin contact, Women's health, Women's rights, Young mothers, Young women

The baby’s here – NOW what ? 

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You have just given birth – it’s your first child and I’m not sure whether you had a Caesarean birth or a forceps birth or your newborn arrived in a birth pool . What really matters is that you receive consistent, evidence based advice from the health care professionals you come into contact with and positive support from your family and friends –  you’ll be exhausted and must try not to rush yourself back to normality too soon – try installing a mindfulness app into your phone and ALLOW your friends to do your shopping/ ironing / take some laundry off your hands . Don’t be too proud to admit tiredness , worry and emotions .

Take a good look at the #MatExp website and join the Facebook page for access to health care professionals , peer supporters and other new parents – ask questions and interact with others so you can gain knowledge and know when to recognise that things might not be quite right .

The biggest thing to hit you right between the eyes is the responsibility of parenthood including how to cope with reduced amounts of sleep , hormone imbalances , post birth bleeding , the increase in laundry (which seems so huge for such a tiny person and more than double with twins !) and how to deal with unexpected visitors who always seem to turn up when it’s nap time . Who said babies sleep all day ?

Well here is my blog to try and help you to make some sense of your early days

Humans have been parenting for thousands of years , babies communicate through crying and facial expressions and you have an inbuilt mechanism that is made to help you to nurture your young . Keep on keeping on with skin to skin contact as new evidence shows that mothers who give their babies plenty of skin to skin contact are more responsive parents . Picking up your baby each time he or she cries is not spoiling the child – HERE IS A LINK TO EXPLAIN WHY A BABY DEVELOPS BETTER WHEN HE SHE IS PICKED UP MORE. UNICEF have lots of evidence based resources and this is a wonderful PDF document UNICEF leaflet on building a happier baby – we are in fact building humans – kindness and compassion towards our young helps the brain take in more information and this in turn reinforces to the child that kindness matters , so he she grows up to be more aware of her / his own feelings and the feelings of others .

Trying to sift thought all the postnatal advice leaflets and decide which friend / in-law , relative has the best advice on getting your baby to sleep is just overwhelming .

First of all don’t push yourself too much to get through one week unscathed – it’s better and more realistic to try and get through a couple of hours feeling positive about what you’ve achieved. Take regular pain relief to help your mobility and well-being and don’t scrimp on rest – did you know that skin to skin contact reduces pain in mother AND newborn?

Let’s move onto  the key things your baby needs to grow and develop as well as feeling nurtured
1.Love which includes feeling nurtured and receiving kindness . Love also means giving yourself kindness and listening to your own mind and body .A baby knows from the tone of your voice whether you are happy and feeling loving towards it – so try hard to keep love in your heart . If you are not feeling this way seek some advice – your love might come later , or you may just be exhausted . If you feel unwell , emotionally drained , or just flat talk to your midwife and let her know – she’s not their to judge you but to signpost you to the correct services available . Do not berate yourself if you are suffering from post-natal depression and/or anxiety – we live in a modern world that doesn’t seem to support the value of resting , being still and calmness – digital advances seem to put more and more pressure on us humans to try and prove we are beyond human – the modern woman  is the equivalent of a plate spinner – don’t take on too many committtments – try practising some self-care and slow down – your body and mind  need rest and stillness as much as they need love , nourishment , kindness and compassion . Here is a wonderful blog about a mother who realised she was shouting too much and was too distracted by others things that led to a kind of moodiness towards her children CLICK HERE TO READ

2. Feeding your newborn is not just about giving a baby milk – the way a baby is held during a feed , the way a mother talks to her newborn and keeping the number of people who give the feed to a minimum has a more positive impact on the baby’s developing brain. I hear many women say “I’m not going to breastfeed as my family want to help me with bottle feeding”.

The first feed of colostrum is a crucial power food to help the newborn to  begin its journey of life. Obesity is a now a public health problem and it’s time to address the low numbers of babies that are breastfed – if a baby maintains skin to skin contact with its mother at birth for over two hours – there is an increase in breastfeeding success – we are talking about not moving baby at all for any reasons including during Caesarean section, perineal sutures, returning to theatre for any reason and always considering SkinToSkin contact.

The postnatal period should include regular prolonged episodes of skin to skin contact to soothe babies , maintain the all important bond with the parents and help milk production . Breastfeeding helps babies to …

1.Recover from birth

2. Feel safe and nurtured

3.protect the immature gut and bowel by receiving immunity from the mother via her bespoke breast milk .

4.feel comforted – because a baby that breastfeeds must be held close and that situation is very comforting to a newborn

The one to “oneness” that #SkinToSkin and breastfeeding gives a newborn is actually is not something that can be replicated in another form – it’s a one off that’s been passed down the centuries , a primitive response that goes back in time to when we lived in caves and our mothers held us close away from other predators . It’s much more grounding for a newborn to feel close to less people and as it gets older you can widen the circle very gradually. SkinToSkin during breastfeeding gives the baby a strong sense of belonging . There are also responsive bottle feeding methods . The SLING LIBRARY offers information about slings across the U.K. click HERE for the website and slings give freedom to do other things whilst carrying your newborn hands free : )

A baby should never be fed without being held – being held during a feed is soothing and promotes a sense of safety & emotional security . Talking , singing and smiling during feeds with intense eye to eye contact is of paramount importance for a newborn’s brain development .

3. Warmth – so important that a baby feels comfortably warm not overheated and is unable to move down under its blankets – the baby’s position should always always be on the back . The “Back to sleep ” campaign was started by Anne Diamond . Click HERE for more information about how Ann spread the word after the death of her beloved son Sebastian died from Cot death at only four months of age. It is now advised that babies are put on their BACKS to sleep and also that they sleep in their parent/s room until after the age of 6 months old . The media in general doesn’t give out evidence based advice and seems to berate parents who choose to co-sleep . Co-sleeping is something that must be discussed and Durham University has a sleep laboratory which has looked at how and why mothers co-sleep with their offspring – Click here for evidence and sound advice about babies sleep . Professor Helen Ball has filmed parents in sleep situations to help us to learn what’s safe and what’s not . The problem with the media is that by criticising co-sleeping they are actually promoting sofa sharing and feeding which is a dangerous practice . Click  HERE for an honest upfront article by the fabulous Milli Hill parenting and birth guru about co-sleeping.

Your house is the environment your child will see as their safe place – so don’t try to change it too much as a temporary measure – keep it as your home to welcome your newborn . You can adapt areas as your child grows and develops . Try keeping changing equipment in two different areas so you don’t have to go to one room all the time .

Let your bedroom be your safe haven where you can escape with your baby to feed , rest and avoid the “popper inners” the visitors who simply turn up unannounced .

Try not to plan too many trips out too soon or those that require a long drive – as mothers soon get tired in the initial few months . A change of scenery is good though and can be a welcome escape from the house . Don’t be talked into your newborn going for a sleepover too soon – when it does happen you may  find yourself unable to relax until you hold your baby again . The other parent can walk the baby whilst mum rests (that doesn’t mean cleaning etc!!) and it’s a good thing to try and learn how to sleep in the day – even though it’s against everything you are accustomed to as a new parent you are  in fact a shift worker so must try and care for yourself or you will become burnt out , exhausted and this could lead to anxiety and / or depression and this applies to BOTH parents.

What about Dads ? Well I love social media and I found this great tool called TheDadPad which is £8.75 supported by the NHS and basically a set of information pads that are wipe clean and give good advice on caring for your newborn as a new dad .

Same sex couples also need support – just because a baby has two mummies doesn’t mean that life is all hunky dory – all parents need to know they are doing ok .

Isolation , poverty and lack of friends can affect parenting- but believe me , not having the latest pram or changing bag does not make you less of a parent . Health visitors are skilled at knowing where there is safe second hand baby equipment which is a lot less expensive – always google the product so that any warnings regarding safety are found before you commit yourselves to it – second hand equipment must come with full instructions and explanations as well as safety recommendations on how NOT to use .

If you feel unwell at anytime in the first 6-8 your lifeline contact is with your local delivery suite . Here waiting isn’t long and you get to talk to a midwife one to one and discuss your symptoms . The problem with going to A & E is that they aren’t designed for mothers and/or newborns and they hold a lot of unwell people . If you have any pains or swellings in your legs / chest pain / fast heart beat / your bleeding heavily / your bleeding has an odour / you are hot and cold please do not delay as any of these symptoms could be a venous thrombosis or signs of sepsis – getting to the Women’s unit faster means quicker diagnosis and treatment . Read about sepsis in more detail HERE on the Sepsis Trust website where you can read about symptoms of sepsis clear concise information.

Refer to your postnatal notes for yourself and your baby for clear advice on minor postnatal symptoms as well as why you may feel unwell – but more importantly talk to health care workers who will give you consistent advice about coping with a newborn . Don’t be fooled by perfect photos – underneath it all most new parents struggle with their lack of sleep .

Try to get out during the day even if it’s just visiting a family member or friend at a house . Being isolated is not a good feeling and can be detrimental not only to your own mental and physical health but also the newborn’s ability to socially connect and brain growth .

In this modern world it’s important to switch off digital devices and talk to babies – if you find this hard reading a book or singing songs is a positive way of communicating.
Keep a mini journal of your days when you felt tired out and see if you are feeling less or more tired as the weeks go by . If you are feeling more tired look at what kind of activity you missed out on OR overdid . Did you eat well ? Rest ? See friends ? Spend any time in skin to skin with your newborn ?

I’ve written this blog so you can try to find information that’s sensible and not prescriptive and I hope you find it useful . If it’s any consolation I was totally exhausted for months and I developed post-natal depression which wasn’t really talked about much in the 80s. I even left my daughter in her pram outside the local post office , not realising until I had say down with a well deserved cup of tea – needless to say I ran back for her and never did that again !! So you see if I can admit to that , what do you think other new mum’s have got up to ?

Becoming a parent is lovely but it is not as perfect as it’s made out to be. Best beginnings have launched a series of films called “Out of the blue” and CLICKHERE for a link to a film on how new mothers can learn to look after themselves . If parents take good care of themselves they will be more likely to care for their children well and be positive role models .

I hope my blog inspires you all on the start of your journey as parents and I wish you and your newborn love , kindness and understanding ❤️<<<<
gt;

Antenatal education, Anxiety, Birth, Breastfeeding, Caesarean section, Compassion, Courage, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Human rights, Intra-operative care, Kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, Newborn attachment, NHS Systems and processes, Obstetrics, Patient care, Post traumatic stress disorder, Postnatal care, Psychology, PTSD, Respect, Skin to skin contact, Women's health, Women's rights, Working from the heart, Young mothers, Young women

Fear of birth 

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How can midwives help women who have a fear of birth ? 

If you meet pre labour I cannot over emphasise the benefits of using a doula service – doulas connect with women and support them through pregnancy , labour, birth and the postnatal period – I value all doulas and I have learnt so much from them . 

Sit beside the woman at her level , listen carefully with your eyes and your  ears . Demonstrate that you accept her fear as real and tangible and do not dismiss  it by saying “you’ll be fine, lots of women give birth”. When as a midwife you first meet a woman, it’s crucial for you to have open body language which means arms by your side , warmth in your eyes, and you should display love and truth . Ask the woman if she wants you to hold her hand , this is a connective proces and a simple yet effective of cementing your relationship with her . 

Help the woman to gain a rapport with you and confidence in herself by demystifying some of her previous experiences  eg the gas and air didn’t help last time , I tore badly last time , I failed at breastfeeding last time. this time it just might . Be a source of knowledge and light for her .  Explain that you are with her that you love your job and you will be her advocate throughout .  

Explain the process of pain in the cervix and why relaxation can help , use mindfulness links for her to listen to and actively take part in them with the woman and her partner to show your commitment to them both . Teach her that an internal examination is about choice, consent and that she is the one in control with an ability to stop the process at any time . Also explain her human rights matte in labour. . The woman may decide against internal examinations – be with her in this decision. 

Hold the woman’s hand when she is talking to you , this will let her see that you are kind and that you  want to help her . Say things like ” I can see vulnerability in your eyes , tell me how I can help you , I am with you” “how are you feeling at this present moment? ” 

Ask what her fears are – one woman I met recently was so scared , she thought that she might die in labour – this may seem irrational but it’s acutely important to know that these expressions of fear are very real to the woman herself . 

Don’t talk about feeding intention , sometimes a woman’s confidence and belief in herself are knocked for six when there have been difficulties with breastfeeding and this can manifest as fear in labour . Discuss instead why her newborn craves for skin to skin with her at birth and that these physiologically magical hours are also to help her feel validated once she has given birth . 

Help the woman to focus on the moment not what might happen this is mindfulness in labour.

If a woman has had a straightforward birth before , her perception of it is what matters not what the notes say or the fact that it appears to have gone smoothly. 

Try your best to stay in the room most of the time , even use the ensuite in the room yourself once you have asked her permission to do so . Your aim is to to reduce her anxiety and fear of being left by the midwife .

Handover information to the team on shift about the woman and her fear of birth so that staff enter the room peacefully and introduce themselves . If someone enters the room and doesn’t introduce themselves, do it for them. 

Ensure that the partners voice is heard and that they see you are trying to help by using open questions . Learn what they do , how they met and see their love for one another . 

Don’t push the woman to have stronger analgesia , the key is give information. It’s crucial to give full explanation of all analgesia and their effects not only on the woman but on the baby and its ability to feed after birth . The pain is the woman’s pain and she must feel heard regarding her analgesic choices. 
Never underestimate the value of finding  a midwife that knows the woman and also suggest aromatherapy. Frankincense is wonderful scent that reduces anxiety and if used in combination with other scents has a calming pain relieving quality . 

Keep the room darker and ask staff to be respectful by not  entering the sacred birth room – interruptions increase adrenalin response which blocks the production of oxytocin and if her partner can get on the bed too this helps the woman to feel safe and loved . 

Explain that you will not talk loudly during the birth and also try not to leave the woman afterwards , complete all notes in the room . Sometimes the most vulnerable time for a new mother is immediately after her child is born . Staying with her to help with positioning and handling of her baby will serve to strengthen her own belief in herself .

Avoid using terms such as “good girl” use the woman’s name to speak to her so that a sense of trust is built upon . 

Explain why prolonged skin to skin contact will help the woman after the birth , it is revalidating

If you think she might need your help with a shower or bath that’s fine – ancient cultures have washing rituals and cleansing is sometimes quite cathartic for a postnatal woman plus you are showing that you care about her and reaffirming that human kindness makes a difference to someone’s experience .

It’s important to be aware of fear of birth and how it manifests in women sometimes it’s difficult to recognise  in the antenatal period and might not be disclosed until labour . Women with a fear of birth  must’ve given time , feel listened to and feel supported . 

Whichever way the birth takes place stay with the woman , and be a constant for her . 

Read as many articles as you can about fear of birth let women know that you understand , follow @FearOfBirth , Yana Richens is a consultant midwife at University College Hospitals London NHS Trust who has just submitted her PhD on fear of birth , she has extensive knowledge and experience . Also Kathryn Gutteridge aka @Sanctummid who is a consultant midwife at Birmingham Women’s who recently co- hosted a tweet chat on  the @WeMidwives platform together with   @TheLovelyMaeve  Maeve O’Connell (a senior Irish Midwife who has also submitted her PhD) . The tweet chat discussed  the subject of Tocophobia . 

Lastly try to write a birth story for the woman from her newborn . When a woman sees words on paper that reflect how she gave birth and her newborns belief in her the effect is indescribable . This will pass into the next generation and you will be affirming birth to many others who read the letter. Never underestimate the effect that your actions , inactions or displays of love , kindness and compassion will have on a woman and her family , they will unknowingly to you. Quite simply your support kindness and compassion will last much longer than a lifetime. 

Thankyou for reading and thank you to wonderful Claire Harrison midwife and friend for believing in me and inspiring me to write this piece .

Love from Jenny 💛❤️💛XXXX

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#LeadToAdd 

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LeadToAdd click HERE to learn more is the latest NHS England campaign # is #LeadToAdd. As a Caremaker I will be linking this on Twitter with my work on #skinToskin , #futuremidwives and #couragebutter to inspire others to see themselves as leaders regardless of their role . Patients, women, families and non-clinical staff are also leaders .  
I feel this will inspire/activate different meanings to different people

Here are some of my thoughts around it

What does to lead mean ? 
To take charge , to be at the front , to inspire , to educate, to be diverse 
Leading is about being at the front and CONSTANTLY looking back to bring others with you

Leading is about being the first to begin something but not necessarily holding onto that but looking at how your actions impact on the way others fulfil their role. Leading is being a positive role model, leading is about looking inwards at your own behaviour and also looking outwards at the behaviour of others . 

In the NHS all staff need encouragement to recognise themselves as leaders and also to see that some behaviours do not embody leadership. We are all learning each day, so don’t stay still – question yourself and the way you speak to others . Ask a colleague to listen to you talking to patients and staff and to give you feedback -what could you change ? Integrate telephone conversations into drills training-  talk to your practice development team – think outside the box . 

Someone who leads others into poor practice is a poor leader but a leader non the less so be aware of your own commitment to pass the positive leadership baton . We are human and it’s ok to make mistakes , however we must learn, evolve and change .

The other day I had a car journey with Joan Pons Laplana (@ThebestJoan on twitter) and once again he made me think hard about how the 6Cs are integrated into practice . Joan said to me that as a health care professional all tasks and procedures must embody the 6Cs – even answering a telephone call. 
As a form of reflection I’d like you to read passage one and then passage two
Passage One 
Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . 
Midwife ( confident and cheery) ” hello labour ward , midwife speaking how can I help you?”
Tony (nervous voice) ” oh hi – err my partner thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone. 
Midwife “oh right well I need to talk to her please and decide what’s happening’  
I’m not going to continue this but could the midwife change her approach ? Is this midwife you ? A colleague? This approach has been learnt from a peer
Passage Two 

Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . ….

Midwife ( confident and cheery) ” hello labour ward , my name is Darcy Jones I’m a midwife and how can I help you?”
Tony (nervous voice) ” oh hi Darcy – I’m Tony – err my partner Dolores thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone. 
Midwife “ok well I would like to take some details first whilst Dolores has a contraction . Thank you so much for ringing us . How are you feeling ? This is your first baby ? How exciting for you both!” 
I’m not going to continue this but could the midwife change her approach In either scenario – which is the best one in your opinion ?  ? Is either of these scenarios you ? A colleague? This approach has been learnt from a peer. 
So you see two examples each one leaving the person contacting  the service with different emotions . 
Start your journey as a #LeadToAdd leader today  ❤️
Thank you for reading 
Love , Jenny ❤️

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 . 

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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 😁

 

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&nbsp;

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/&nbsp;

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