What you can do to save midwifery as an independent profession in the UK.

By Ruth Weston and Emma Ashworth

Independent Midwives are in the NMC firing line, and most of the campaigning that you might see is about this. However, the NMC (Nursing and Midwifery Council), which made this decision, did so without a practicing midwife on the board, and the ramifications of the decision affects every midwife in the UK.

For instance, the NMC have stated, “A registered midwife can only attend a woman during a birth if she has appropriate indemnity cover. The midwife cannot avoid this legal requirement by attending the birth in a ‘non-midwife’ capacity… The only exception to this is when a midwife attends a birth in a personal capacity to support a family member or close friend for whom they have not previously provided midwifery services”. “Services” includes emotional and physical support, meaning that midwives are being banned from attending the births of their grandchildren, or their own babies in the case of male or lesbian midwives if they’ve so much as listened in, or supported their partner through morning sickness.

The NMC is removing the midwifery committee, which advises the NMC on midwifery matters. Its replacement will have no budget and delegatory powers and it is unclear who will be on it and what its role will be within the NMC. As the NMC – the NURSING and Midwifery Council – has overwhelming numbers of nurses compared to midwives, and the way it is now being set up means midwives will be regulated by a completely different professional – one geared to nursing sick people rather than caring for healthy women -without their own voice being heard at all.

There is a huge risk that this will toll the death knell to midwifery as an independent and autonomous profession. becoming subsumed into the nursing profession as another branch of nursing.  This is certainly the way the NMC and the Government legislation is treating midwifery at present and would mean Midwives would lose the status of being THE professional experts in the normal maternal pathway and key care provider. This is not inevitable but as a profession and as parents we must rise up and clearly and strongly oppose  the removal of the midwifery code, the midwifery committee and lack of representation for mothers and midwives at the NMC. The profession has never been in more jeopardy, and never has the care of women and their babies been so much at risk since the formation of the profession of midwifery.  It falls to us to do something about it..

What can I do?
1) There have been several petitions. The writer of this one admits that if it had been less rushed it would be better worded, however, if we want Parliament to take note of the voices of women, midwives and their families then this is a good petition to start the ball rolling, so please do support it. https://petition.parliament.uk/petitions/178561

2) Share your story of how midwives have helped and supported you. What impact will the lack of access to IMs have on you?  Share on:

Facebook, Save Independent Midwifery page: https://www.facebook.com/groups/443681876022589/

Send to Birthplace Matters who is preparing stories and letters to the NMC through  birthplacematters at yahoo.co.uk

Send them to the saveourmidwvies.co.uk website.

Don’t forget to include permission to share.

3) Tweet!  Use the #savethemidwife hashtag with your messages about how this affects you. You can  tag Jackie Smith of the NMC using @JackieSmith_nmc, and BBC Watchdog (@BBCWatchdog)

4) Write to your MP. The website saveourmidwives.co.uk has important template letters which answer the cut-and-paste responses that most MPs are sending. Find your MP here: http://www.parliament.uk/mps-lords-and-offices/mps/

5) Join IMUK, the Independent Midwives’ professional body, as a supporting member. It only costs £20: http://www.imuk.org.uk/professionals/join-imuk/

6) Make a complaint to the NMC. E-mail complaints@nmc-uk.org. They have less than 20 working days to respond. It is important to mention that it’s a formal complaint to ensure that you go straight to Stage 2 of their complaints process. If you don’t like the reply, simply respond back, say you’re not satisfied, why, and then appeal the complaint response, escalating to Stage 3.

7) Many women and Midwives across the UK are using their passion, creativity and skills to support independent midwives and to challenge midwifery regulation to do its work better.  Do what you can with the people you can, and watch this space as more developments are in the pipeline.  Thank you!

Advertisements

Image

Save the NHS – Waterbirth!

“A woman in birth is at once her most powerful, and her most vulnerable.” Marcie Macari

There are some areas of maternity care which are so valuable, so game changing, that it is remarkable that they are not the default offering for women in labour.  At our most vulnerable time we can be supported to be our most powerful.  Labour and birth in water can transform childbirth, and at the same time it fulfils a vital requirement of our health service: to save money.

Jeremy Hunt continues to force the NHS to make “efficiency” savings, and the NHS has an obligation to provide the best care that it can. Given that waterbirth firmly ticks both of these boxes, it is essential that all trusts ensure that they are providing a sufficient number of birthing pools to be able to offer them to all women who wish to use water.

Tell me more about these cost savings

In summary, water labour and birth compared to land labour and birth reduces the number of interventions or complications that women experience. Some interventions and complications cost the NHS money immediately (such as caesareans, forceps, transfer to the hospital from an out of hospital birth, chemical pain relief) and some also create costs on an ongoing basis due to follow up care (eg caesareans, perineal damage, birth trauma).

Let’s back that up with some research.  Looking at caesarean sections, an Italian study in 2014 found that the women in their study who birthed in water had a 94-99% spontaneous vaginal birth rate, in a country where the caesarean birth rate is 38%! A follow on evaluation of Birthplace 2011 showed a reduction in risk of caesarean birth by 20% for first time mothers. The same review also showed that the number of women who were transferred to hospital having planned an out of hospital birth was also significantly reduced for women who laboured in water.

A 2004 observational study over a 9 year period found that waterbirths reduced the risks of perineal tearing, episiotomies and reduces the mother’s blood loss. This leads to NHS cost reductions in follow up care for tears or cuts, and for treatment for anaemia – and leads to a reduction in women coping with new parenthood without being able to sit comfortably (something that we all need to do a lot of as we feed our newborns), and reduces the number of women coping with pathological exhaustion on top of normal postnatal tiredness.

This is just a very small summary of the evidence that is available, because there are hundreds of studies which show the benefits of waterbirth to women, and to the NHS, which we will continue to blog about over the coming months.

Let’s put this into practice!

Aquabirths came about because of my passion for supporting women in birth, and because to be able to ensure that women have access to a pool if she chooses to birth in a hospital or midwife led unit, trusts need to be able to afford the capital cost of installing them. The original investment will be repaid by saving just a couple of women from an unwanted caesarean, and the human cost of an unwanted caesarean is priceless. Aquabirths fitted pools are available from £2900 including plumbing components, and are discounted even further when 2 or more are ordered. They’re manufactured in one piece to make fitting as easy as possible, and Aquabirths will do the installation if required.  The pools are easy to repair in the very unlikely situation that they’re damaged, due to their fibreglass construction rather than plastic, and they also come with an industry-best 10 year warranty.

Ongoing care is made easy and cheap by the fact that the baths are manufactured in one piece, making cleaning and hygiene control quick and effective. All plumbing components are standard parts, so they’re easy to replace if required, although this is very rarely needed, just like it’s almost never the case that you need to replace plumbing in your own home.

In a follow up post I’m going to talk some more about access to birth pools. At the moment, many trusts have a policy which means that many women are not eligible to use them unless they’re classed as “low risk” (a term which I should also cover at some point!). I’ll just leave this post with one final thought. “High risk” women are often denied access to a pool, but told to take a bath, and the same women are denied access to a pool, but instead offered heroin (diamorphine) in labour without being told what they’re being given. It’s time to take another look at labour and birth in water and the benefits of it to women, babies,

…and trust finances.

Aquabirths are running a special offer of a free birth couch (currently £795, normal price £950) with every Canberra, Venus or Heart-shaped Birthing Pool. Use code SB161102  when ordering the Pool.

 

NMC Consultation – Respond before 17th June and here’s some help with doing it.

Guest Blog by Rachel Gardner of Forging Families

Dear Friends,

This is the most important thing I have ever written, and I implore you to read it and act upon it by answering these two questions in this government questionnaire.

This is not about labour or conservatives, this is about midwives and women and birth and about saving women’s choice in birth and about saving the midwives who support these changes.

Please get involved and get others involved. The deadline is 17th June. ACT NOW.

THE MOST IMPORTANT QUESTIONNAIRE YOU COULD EVER COMPLETE.

This questionnaire is here:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

It is for professionals and the public but is worded in such a way that most members of the public would not fully understand what is being asked.

There are two questions that you MUST answer. The rest of the questions you can skip but the first two please respond too, and then submit your questionnaire to the government.

Question 1 is:

Do you agree that this additional tier of regulation for midwives should be removed?

This question is referring to the role of Supervisor of Midwives. Supervisor of midwives role is to protect women’s choice, and women’s choice regarding their birth is one the most important things in maternity. Supervisors of Midwives support women choosing birth outside of ‘policy’ or outside of specific guidelines.
Without the role of Supervisor of Midwives the potential is for Trusts to refuse to care for women choosing care outside box guidelines and there will be no protection or support for midwives providing care in these instances.

This would be a catastrophe for maternity care and for women and for choice in birth.

Midwifery supervision brings challenge to Trusts when advocating for the safety of women. This is a healthy level of challenge ensuring Trusts management maintain women’s safety as the focus of their care, enabling women’s choices to be listened to and respected. SoMs also work collaboratively across trusts sharing best practice, completing external investigations and providing “fresh eyes” on midwifery practice. All this has the potential to be lost with the removal of the regulatory function of Supervisors of Midwives.

Do we agree with this happening? No, no no!

Question 2 is:

Do you agree that the current requirement in the NMC’s legislation for a statutory Midwifery Committee should be removed?

Considering the NMC stands for Nursing and Midwifery Council there is poor representation by midwives in the council. If the midwifery Committee is to be removed from the NMC the voice of midwives will become weaker than ever. Someone has to protect the function and role of a midwife or it will be lost forever. Allied health professionals are not just nurses in the same way as midwives are not just nurses. This is like physiotherapists being regulated by radiographers. It just doesn’t make sense. The professions although within health are completely different.

Should we remove midwives from the Nursing and MIDWIFERY Council? No, no, no!

Proposed NMC Midwifery Changes: Modernisation or Mutilation?

Guest blog by Emma Ashworth

The Department of Health has released its consultation document on proposed amendments to the NMC and ALL midwives should read it, understand it and comment on it.  This consultation has put together a number of different proposals, each of them hugely important in and of themselves, and each which need to be addressed and considered separately.

I have long been irritated by the fact that when consultations are drafted, their wording is directive, designed to influence the outcome to that which the Consulter wants.  This NMC consultation is no different.  The title, “…amendments to modernise midwifery regulation and improve the effectiveness and efficiency of fitness to practise processes” states that this is what the amendments will achieve.  Who doesn’t want modernisation? Who would disagree with improving effectiveness and efficiency? Who wouldn’t want fitness to practice processes improved?  And yet… let’s look at those words.  “Modernise”.  Not changes, but modernisation.  Removing Statutory Supervision is not an alternative way of supporting midwifery practice, but a “modernisation”.  As is pointed out to Arthur Dent, “there’s no point lying down in the path of progress!” but when there’s a large yellow digger coming to knock down your ability to support women to access services outside of guidelines then shouldn’t we all be lying down in the mud?  (Note: if you don’t know why people are lying down, or why diggers, once you’ve read and commenting on the DoH’s proposal, go get a pint of beer, a towel, and read “The Hitchhiker’s Guide to the Galaxy”)

Statutory Supervision was torn apart following the Morecombe Bay enquiry, where it was decided that there was a problem with the combined role of the Supervisor to both support midwives in their caseloads and at the same time be responsible for investigating complaints against them.  This has been a concern of a number of people before the enquiry, but a solution that did not remove both functions was not investigated by either the DoH or the NMC.  A “modernised” Supervision role should surely create a way that both roles could be fulfilled without any conflict of interest.  For example, two different roles might be created with different people in the Trust holding them, or the investigation of complaints might be moved to the LSA, and the supportive role of the Supervisor be kept within the midwives as is the current position.  There may be a number of ways that this could happen which would not remove the vital role of supporting midwives to support women, and it is this role which is being removed from being statutory.  This is the absolute crux of the issue.  If something is not statutory Trusts will not do it.

The devastating, NHS destroying Health and Social Care Act meant that the CCGs have absolute power to decide on care services, with nothing other than emergency care being mandatory.  We have all seen the catastrophic slashing of services across all areas, not just maternity. We can’t even invest to save, for instance by creating a continuity of carer service which we know would drastically improve outcomes and save vast amounts of cash, even if it takes work and a small investment to set up.  There is a cost to supporting Supervision. How likely is it that it will continue when it is not a requirement?  What will midwives do, then, when they are trapped between women’s needs and wishes, and “guidelines”?  What will you do?

Have your say and respond to the consultation here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

Read more: https://www.rcm.org.uk/news-views-and-analysis/views/department-of-health-releases-consultation-on-nmc

Next: Abolishing the statutory Midwifery Committee

 

 

Supporting mums: breastfeeding a baby with Down’s syndrome

Magdalena's Milk bookcoverJPG.jpg

Guest Blog by Anita Kolaczynska

Our youngest daughter, Magdalena, is ten and just had a party with twenty of her friends. She breastfed into her fifth year, when she self-weaned. She enjoys karate, Brownies, horse-riding and swimming. She likes to eat pitta bread and humous while watching T.V. She doesn’t like babies or being rushed. Her happiest place is outside, helping out with our goats and hens. She is fascinated by the natural world; delighting in recounting extraordinary animal facts. Her and her big sisters get up to the usual sibling fun and mischief and Magdalena stars in an annual documentary series that one of them makes about their life together. The award winning films are called ‘My Little Sister (who happens to have Down’s syndrome)’

When someone you are supporting to breastfeed has a diagnosis of their baby having Down’s syndrome, the mind is likely to conjure up a different image to the person that I’ve described above. Most people are unlikely to imagine an individual with her own interests and character, who feels the whole range and depth of human emotions and who is fully included in family life and her community. In truth, just as no two people are alike, no two people with Down’s syndrome are alike, so why we should build any picture at all is crazy-but we do. So, cancel those pictures and projections of what you think you know and instead see the baby you have in front of you and focus on what her needs are now this minute, this hour, this day.

When a baby is diagnosed with Down’s syndrome, the baby is often talked about as a collection of potential medical issues. A plethora of professionals are involved using medical jargon, often giving conflicting information as they test, diagnose, examine, fill out paperwork – the overload of information and aura of anxiety about an uncertain future, can leave the parents feeling left without a voice and disturbed that their baby is not being treated as an individual. Within this vulnerable context many mums get told ‘Downs babies don’t breastfeed’

Putting aside for a minute that this statement isn’t true, look at what else the mum is hearing here.

  1. Her baby is being defined, therefore limited, by having an extra chromosome.
  2. Her baby is already being talked about in terms of what she can’t do.

This is why “person first” language is important. Please say: ‘a baby with Down’s syndrome’ This way the individual comes first, the condition does not define the person. Read the guidelines on what to say/not say and educate people where you can:

http://www.downs-syndrome.org.uk/about-downs-syndrome/what-to-say-what-not-to-say/

Babies with D.S. do breastfeed successfully. Those who experience difficulties may take longer getting breastfeeding established but with the right support can go on to have the breastfeeding relationship they want.

Mythbust-If the baby is having difficulty feeding from the breast then the bottle will be easier.

Not true, the baby is likely to tire just as easily and find the co-ordination skills needed to feed just as difficult, the same patience and persistence will be needed, whether feeding with breast or bottle.

The benefits of breastfeeding dramatically increase for a baby with D.S. Conditions that are more common, such as lowered immunity, respiratory infections, constipation, low muscle tone, all improve with breastmilk and of course breastfeeding aids in the development and co-ordination of oral muscles as a pre-cursor to speech.

Babies with Down’s syndrome are commonly slower to gain the initial weight lost after birth.  Many professionals are not using the growth charts specific to D.S. The weight loss and different feeding needs to a typical baby can trigger fear and panic and escalate to hospitalisation/drip/formula, ending the breastfeeding relationship and leaving the mother robbed of her choices and doubting her instincts.

This is why the support of a breastfeeding counsellor is so valuable.  You may be the only person who, through responsible monitoring of all the signs of thriving, has the courage with the mother to wait. By supplying the mother with accurate information and supporting the mother to stay close to her baby at all times, and learn how to recognise and respond to her baby’s cues you are also empowering her to take ownership of her baby back and upholding her ability to nurture and mother.

-Make sure the right growth charts are being used. You can download charts here:

Growth charts specific to babies with D.S.

http://www.dsmig.org.uk/information-resources/personal-child-health-record-pchr/

A trained breastfeeding counsellor will assess each mum and baby as individuals and suggest ways to address specific issues.  Don’t compare her baby with other typically developing babies or other babies with D.S. Compare this baby with itself, notice progress and celebrate each small step.

Common issues when a baby with D.S. is having difficulty breastfeeding:

Mainly these arise through a heart problem and or hypotonia (low muscle tone)

Heart problems get fixed with surgery and hypotonia improves as the baby develops.

The issues that present can be all or any of the following:

Sleepy babies-extreme tiredness/lack of energy/falls asleep after a few sucks

This means waking your baby up to feed every few hours throughout the day and night. Feeding little and often, lots of little breaks within a feed to keep baby awake and allow milk to digest. Maximising signs of readiness to feed, don’t wait when you see lips/eyelids move slightly. Stimulating baby to keep feeding through massaging/blowing/taking off clothes, wake up if falling asleep after a few sucks by changing nappy, putting back to the breast…

Poor latch, difficulty maintaining latch

Experiment with supportive positions to support baby and breast, Practical breastfeeding support-use supportive positions like dancer hold, breast compression, support breast and baby’s jaw at the same time to maintain seal.

Expressing/SNS/using a syringe can be useful if baby is not feeding long enough to get sufficient hindmilk.

Massaging whilst feeding, blowing on baby’s cheek, cool flannels to keep baby stimulated and awake.

Express some milk first, if flow too strong for baby.

If baby is arching, floppy, difficult to support-try swaddling.

Smaller passageways can block easily. Keep baby’s ears above their mouth. Semi-upright positions are often better to feed in.

Can use steam infuser to clear congestion.

Massage to aid digestion.

Lots of skin to skin.

This all takes an enormous time commitment before baby gets stronger, is less vulnerable and breastfeeding happens with ease. So, lower time expectations, acknowledge everything will take longer, patience and persistence will be needed but breastfeeding will get easier. Think of 3-6 months rather than 6 weeks. For mum to be able to commit to the intensity and length of feeding her baby, good support networks are so helpful.  For instance, help with other children, meals, housework need to be put in place if possible.  There are organisations like ‘homestart’ to help if family and friends aren’t around.

So I’ve been called in to help, what do I do?

Congratulate the parents on the birth of their beautiful baby, pick her up, cuddle her, look into her eyes, notice that she looks like mum/dad/big sister…smile and be joyful that you have the privilege of meeting this new life and have a valued role in supporting this mum and her baby.

-Go to the D.S.A. website http://www.downs-syndrome.org.uk/about-downs-syndrome/truth-and-fiction/

Familiarise yourself with the myths and outdated language, choose to evolve the future by not perpetuating the stereotypes of the past where our babies with D.S. were institutionalised and deemed uneducable. There are leaflets for new parents and a free helpline. Make sure your mum knows about these.

-Don’t assume you know more than the mum or how she is feeling; empower her to get to know her baby by watching for cues of readiness to feed.

-Acknowledge her commitment, time, patience and the value of what she is choosing to do ‘I am here to support your choices’

Watch and share these films to educate and change perceptions about Down’s syndrome

My Little Sister (who happens to have Down’s syndrome)

Positive uplifting documentary series about real life with a sibling with D.S.

http://www.agik.co.uk/my-little-sister/film/

Keep Calm MLS logo copyright

Agi with her little sister Magdalena

Anita Kolaczynska’s little book and ebook ‘Magdalena’s milk-Breastfeeding and Down’s syndrome’ is to be published later this year. Anita is available for consultations, runs workshops and gives presentations about Down’s syndrome and breastfeeding. You can contact her at:

http://oakwellbarns.co.uk/breastfeeding-your-baby-with-downs-syndrome/

 

 

Breastfeeding community building

A guest blog today from Lucy Sangster, who’s been reading up on the latest breastfeeding research for us.

New research shows how peer support for breastfeeding helps strengthen local communities. While existing research on breastfeeding support shows that it is effective and valued, work on how it fits into social cohesion has been missing, according to the authors of a new study: Gill Thomson, Marie-Clare Balaam and Kirsty Hymers.

Reading their work on Blackpool’s breastfeeding peer support, the value of the research is that, at a time when provision is at risk, proving wider benefits for breastfeeding support may well help groups argue for funding and gather more allies for breastfeeding support in their own areas.

The full report is packed with stories, quotes and evidence of what is working in Blackpool, here’s a summary of some of their findings.

There are really determined efforts to remove barriers to breastfeeding in Blackpool:

  • A crèche is provided at meetings
  • A peer will meet someone new before a meeting so there is a familiar face for them
  • They get to know women before the birth
  • They involve peers from some of their minority communities
  • They go out to people who are less likely to get in contact: at young parent groups and at a supported accommodation centre for homeless families
  • They involve partners, families and grandparents, so that they understand and can support breastfeeding
  • They raise the profile of breastfeeding in Blackpool with events, local media, work in schools, and wearing their ‘uniform’ t-shirts around town
  • They’ve made breastfeeding feel more normal through local businesses displaying a sticker ‘breastfeeding friendly business’ so a less confident woman doesn’t need to worry about whether it’s ok to breastfeed.
  • They work hard to get the support of health professionals in the area with communication, feedback when a referral takes place, concentrating on shared goals and support.

Because the study has used an existing model for social cohesion (made popular by Ted Cantle nearly 15 years ago) they are able to look at several different impacts of peer support. They show that peer support breastfeeding can help women create bonds with other similar women that last beyond breastfeeding; it can also create bridges between people with little else in common and form links between mothers and people with more power.

The inherent tensions between professionals and volunteers are given space within the report and anyone who has worked in a system including both professionals and volunteers would recognise that when working well, everyone wins… but it can be hard to keep it working.

The study shows that clear communication with professionals and proving how peers support them helps the peers maintain good relations with health professionals.

‘“I think at first the health visitors were the hardest but now they’re great. Because it’s showing them how you can help them as well, that you’re there to support them, that’s what it’s about.”’

The main sources of tension were when there was a lack of communication, conflicting advice, feeling there was no common agenda or negotiating hard cases such as a baby losing weight.

Previous research suggests that peer support for breastfeeding can do harm as well as good, particularly by inducing guilt or imposing pressure, so the feedback that the peers in Blackpool were non-judgemental and approachable is valuable, to indicate that they’re avoiding some of the pitfalls.

In the full report you can read more about how the service was set up, how they changed it and how they made the peer role flexible so that people with caring responsibilities are included. There are also details in the references to the recent Cochrane review on the effectiveness of skilled support on increasing the duration of breastfeeding and other research on the subject.

What makes a birth centre?

I’ve been privileged to talk to two women who were central to making the Bradford Birth Centre so successful. Alison Brown has recently retired as consultant midwife in normality and Deborah Hughes was project lead in setting up the birth centre. They’ve both moved on and would like to share their experience of enabling natural birth within the NHS in the kind of “alongside midwife unit” encouraged in the new NICE guidelines on low risk birth.

The Bradford Birth Centre now deals with a third of Bradford’s births – around 2000 every year – and offers an environment for a genuinely woman-centred natural birth. It’s taken hard work and a lot of determination after decades of only having an obstetric led unit. But it can work and it does work, so here is the journey that these pioneers took Bradford on.

More than procurement

Both midwives were clear that you need more than the right equipment. As Alison says, “Before the birth centre, we had a pool and it was part of the wider maternity ward but we had a terrible struggle getting midwives to use it… Once it was part of the centre you couldn’t stop them.”

We’ve got a great idea!

At the start, finding allies was key. Who can stand up for the aim of woman-centred birth through the organisation? Deborah says that “having other people keeping an eye on it and championing it” helps an idea grow.

One key ally was Ruth Weston, then Chair of the MSLC, who was able to deal with stumbling blocks and maintain pressure by writing letters and asking questions in a public forum like the Trust AGM.

Even now, the centre benefits from having allies, as community midwives spread the word about the centre, the benefits of their approach and how best to access it.

Creating a confident team

Midwives who were used to labour ward practices benefited from training on natural birth, traditional midwifery skills, alternative pain relief like hot compresses and the role of Oxytocin. They looked again at the language they could use to encourage natural birth. Gradually a group of people committed to a new way of working and a different culture of birth emerged.

Culture is a word that Deborah and Alison keep coming back to. And of course with staff changes, building that culture isn’t a one time job. New midwives work closely with experienced staff. One new midwife told Alison that she felt anxious using water: ‘I can’t see the baby’s head coming out and I don’t want to pass my anxiety onto the mum’. She felt able to tell someone and wanted to deal with her anxiety rather than restrict the options of the women she was working with. That’s the power of a new culture. That midwife received training and even paid for it herself.

A kind culture

Deborah praises Birth Centre Manager Carol Dyson for working on the idea that a different culture meant staff being accessible, kind and warm hearted. Kindness, as Deborah calls it “the gentle stuff”, works right through their practices. Birthing women and staff mingle together, with the whole space open and mixed.

That attention to mood helps women to feel safe and trust the staff. In an age where women often doubt their ability to birth and presume they’ll need a lot of intervention, it takes trust to believe someone saying that rather than having an epidural straight away, try the pool first.

“It’s really sad,” says Alison. “They presume that having a baby is such a risky thing that they’d never be able to do it without lots of intervention and help. We need to give women the confidence that they can have a baby.” And yet, “if you get them in the pool they take a sigh of relief, it lowers the stress in the whole room. You can see the birth hormones kick in and they let things go a little. It relaxes everyone. It’s amazing when you see it.”

Using the space as a whole

As the centre was a small space – seven rooms off a main corridor – one of the key decisions that made it work was using the space as a whole rather than keeping rooms and women separated.

Deborah used her experience from working in Calderdale. Using the space in this way means that the pools can be in constant use and more women can access the centre. “Women can move around and use it how they wish rather than being stuck in one space. Wanting one space tends to be a safety issue and when women feel the space belongs to them and is safe, they don’t mind moving around the whole unit.” A woman moving from a pool to a bed to a sofa is a normal part of birth in the centre.

It meant that while there are only two pools in place, 30 per cent of women give birth in them, with many more moving in and out during their time there.

Policies that stick

Policies take a long time to agree and can be a frustrating part of the process, but both Deborah and Alison emphasise how important they are. Deborah said, “It took over a year. It was very important that everyone knew from the beginning what was going to happen. There were things that we were willing to be flexible on that we had to define so that other people were comfortable.”

They talk about three key steps:

Firstly you need to set out your goal. For the birth centre, the goal was creating the right environment for woman centred natural birth. Everything else was judged against that goal.

Secondly there’s no way to dodge difficult decisions. The team in Bradford decided that women who transferred to the labour ward wouldn’t have continuity of care – the midwife wouldn’t move across with them – because losing staff would make the centre unviable and would stop another woman from taking her place. Continuity of care is rightly important, but they had to consider the hard case of whether it had priority over their main goal.

They couldn’t get agreement to allow access for women who wanted a vaginal birth after a C-section (VBAC). Deborah said “You don’t want any mistakes, heroics or drama”: it felt more important to get agreement and then revisit policies when they could.

Thirdly, there are other parts of the organisation with concerns and the ability to stall progress. In Bradford, after the concerns of the Estates team had been worked through, there was a long running issue with the Moving and Handling Team who insisted on the centre using hoists when getting in and out of the pool. Alison said “We even had people just coming in saying that they’ve come to measure for a hoist! We’ve had to bar the door! We set up a plan for anyone who did collapse in the pool, it works well and we don’t need a hoist. However it’s just part of the problem that the NHS organisation just does not get water birth. We’ve had a similar battle with infection control”.

Who’s the gatekeeper?

The team fought a long time for the principle that women should judge when to access the centre. Deborah says that experience from past work suggested that this was vital to meet their goal. Usually a triage team responds to women asking to be admitted and therefore they effectively get to say when labour’s started and whether the woman is ‘allowed’ to come in.

Instead Bradford Birth Centre ensured that women contact them directly. Women get to choose when they want to access the centre and if there isn’t yet space but they want to sit in the soft seating area and have a hot drink that’s fine with the centre staff.

Despite worries that the centre would get ‘bunged up’, it worked well. Instead of a judgement from triage, first contact is the centre’s way to establish relationships and trust in the staff.

However this is sadly an ongoing battle and it’s an example that even with success, you have to keep arguing your case to avoid sliding back.

Separate and different

What may surprise is how strongly both midwives felt about being separate. The way of working and the environment is so different in the centre that the larger organisational culture is quick to take over again. Whether that’s doctors walking through and imposing decisions, midwives picking back up labour ward ways of working because they get ‘taken off’ their centre work for other priorities or triage deciding when labour starts, separation is key to the goal of enabling woman centred natural birth. Just moving to another part of the building from the labour ward has a big impact.

The future

Separation is important right now, but Alison has spent time finding ways to support higher risk women in the labour ward to achieve the same experience as you’d find in the birth centre. “From the woman’s perspective, it doesn’t matter how many complications or risks you have, women still want a nice environment to birth in. The reason they don’t get that is really complicated though. The ward should be recognised for their high rate of vaginal births. But it feels to staff as though they can’t look after people and have them in the pool.”

Despite working through case studies, buying high tech monitoring equipment and having pools in place, the ward isn’t embracing natural birth yet. Can you recreate that birth centre culture in a labour ward? Alison hopes that her successors keep trying.

Alison finishes by saying, “Changing the culture takes time and is a challenge, we had people trying to tell us that women in Bradford won’t want to use a pool! But when they know it’s there they beat the door down, they start to realise that it will work for them and be a great thing for their birth.” With 2000 women passing through each year, that’s a huge impact on women finding out what a good birth can be like.

Hypnobirthing: a guest blog by Katharine Graves

Hypnobirthing has changed practice in birthing suites and will continue to do so.  There are many good things that have happened over the years, and all the time I am aware of improvements as we edge towards a more natural and woman-centred regime, but  nothing has made the practical difference that Hypnobirthing has.  It is very important that everyone is aware of and fully conversant with what is going on.

As yet there is little research on Hypnobirthing, though various studies point to the profound effect it has.  I hope this document will help you understand more about it.

The principle behind hypnobirthing is the fear-tension-pain premise put forward by Grantley Dick Read.  In our society, everyone ‘knows‘ that birth is painful so, however much a woman is looking forward to having a baby, which she undoubtedly is, that is the background in which she has grown up.  As long as that background is in place, she is unlikely, after she has had her baby, describe it as ‘the most wonderful and empowering experience of her life‘ which is what I frequently hear from hypnobirthing mothers.

We all know the procedures that go on with heart-breaking regularity in delivery suites.  It is wonderful that these medical procedures are available when needed, but we can’t help asking if they are needed as much as they are used today.  Hypnobirthing educates a mother, and equips her to deal with whatever turn her labour may take.  It cannot promise the perfect birth; nothing could – that would be unrealistic.  But it is amazing how often this is achieved.  Whatever the outcome, hypnobirthing makes a difference, and a very big difference too.  Hypnobirthing gives you the tools to have the best birth for you.

A hypnobirthing course is a full antenatal training.  It is based on knowledge, profound and simple logic, and information.  There is nothing new in birth, after all it has been around for a very long time, but hypnobirthing looks at the facts in a completely different way which makes a dramatic difference.  Midwives who are present at a hypnobirthing birth for the first time are amazed at the calmness of the mother and I often hear the exlamation, ‘I’ve never seen anything like it.  I couldn’t believe how calm she was.‘

A hypnobirthing course lasts for about 12 hours, either 4 or 5 evenings or 2 days, and ideally a couple do the hypnobirthing course together.  They learn:

  • What hypnosis is
  • What hypnobirthing is
  • How the muscles of the uterus and the hormones work in a way which throws an entirely new light on this system
  • The power of the mind (greatly under-estimated by most people)
  • The physical aspects of birth, e.g.pelvic floor exercise, perineal massage, positions, back to back babies, breech babies.
  • Breathing and visualisations that work with the body
  • Relaxations to practice together
  • How to apply what they have learnt when they give birth
  • Common procedures in delivery suites
  • How to get all the information they need in order to choose the best course for them
  • How to release fear

You are also given The Hypnobirthing Book, and the Colour and Calmness Relaxation CD to play each night as you go to sleep to release fears and build a positive view of birth.  This will affect the hormones you produce, which will also affect your baby, and the efficiency and comfort with which you give birth.  You are also given a folder of handouts to continue your practice at home.

People come to a hypnobirthing course expecting to receive a lot of techniques to raise their pain threshold, take them to some spaced-out state so they don’t notice the pain, or not notice as the pain washes over them.  Yes, we give them breathing, visualisation and relaxation techniques, but these have been around for years, so what makes hypnobirthing so different, and so effective?  There are three things:

  1. The work to release fear, so that a woman looks forward to her birth with positivity and optimism.
  2. She learns to relax very deeply; much deeper than a short relaxation at the end of an antenatal class.
  3. Rather than just being told to go away and practice, she is given a simple programme that she can use to continue the work at home. All the best birth reports that I have received have also said, ‘And I practised lots.‘ 

Learning hypnobirthing is completely different from preparing for any other important event in our lives.  If we are preparing for an exam, we add more and more information, we do a trial run, and the night before we really cram it in, and then we produce it on the day.

Hypnobirthing does exactly the opposite.  With each practice a woman learns to let go, and let go, of her fears, her preconceptions, so that by the time she gives birth that perfect system that is already in place in her body and mind can shine forth and work as it is designed to do, comfortably and efficiently.  It is difficult to explain.  It is something you experience.

I have written The Hypnobirthing Book which fully explains hypnobirthing. Since hypnobirthing is having such a profound effect, it is important that all women consider how it can support them in giving birth.

Here is a mother’s description of hypnobirthing:

In late December, my husband and I attended – with a considerable degree of scepticism – your Hypnobirthing course. We had absolutely no idea what to expect and were worried it would be a bit hippie for our liking. In fact, it changed our lives forever and I wanted to say a huge thank you for the epiphany you inspired in us.

On Sunday, March 2nd we welcomed to the world little Felix, who arrived at 7:04pm weighing 8lb 1oz. Felix is heavenly and we are, predictably, crazy in love. But much more significantly – just a few months ago, I was one of those ridiculously well-educated but utterly-clueless-about-birth 21st-century, 30-something professional women who assumed I would march into hospital demanding an epidural and every single drug going. In fact, Felix was born with nothing more than a few sips of water and lucozade and the bath/birth pool to get us through a fairly arduous 16 hour of back labour with literally no respite between surges… No drugs or gas & air, no interventions, no stitches, no perineal tearing.. Just a lot of breathing, TOTAL faith in my body’s ancient wisdom and the perfect system that is already in place, and the spirit of you and Grantly Dick-Read guiding us through! 

Of course I realise how lucky I was to go into labour spontaneously, four days after his ‘due’ date, and not have the pressure of the NHS induction clock bearing down on me – but I’m convinced that my utter faith & conviction that baby knows best and that nature would take the right course played a huge part in that too. I also did an NCT course to meet some local mothers, and of six young, healthy women, I was the ONLY one not to be induced or have a C-section. That must count for something!

You were absolutely instructive in making the impossible possible and inspiring me to go and read Grantly Dick-Read in the original as well as discover many other sources of enlightenment and positive thinking about birth as a miraculous natural non-medical event. So thank you from us all from the bottom of my heart.  The positive changes in mental outlook you encouraged, and the way you taught us about things like the parasympathetic nervous system and so much more, are invaluable life lessons I will take forward far beyond the birth and parenthood.

I’ve already recommended you to many of my expectant friends, some of whom recently came to your course, and there are more of my friends coming to one of your courses soon. I’ll always spread the word about the wonder of Hypnobirthing in general and you in particular.

THANK YOU.

Hypnobirthing is a method for focusing the mind on the positives of birth so that before and during the birth the mother can be calm and relaxed.  This enables the body to work efficiently in the way it has been designed to do, giving the best opportunity for a calm, easy, natural birth.  The method uses deep relaxation, information, logic and knowledge for both mother and birthing partner as a way of removing fears associated with birth and importantly providing tools for how remain calm in any circumstances which may arise during the birth, thus removing any unnecessary pre-conceived worries.

Birth is the most formative experience of our lives and, if a mother is calm and drug-free, her baby will also be calm and drug free.  Instead of birth being a traumatic experience for both mother and baby, it will be a gentle, natural experience with fewer interventions, which mothers describe as the most wonderful and empowering experience of their lives.  The baby will arrive in the world to be greeted by a mother who is calm and alert and ready to receive it.  This is how it forms its first relationship in this world, which is the blueprint for every other relationship throughout its life, and will have an effect on it throughout its life, and indeed on everyone it meets.  Time and time again, people observe that HypnoBirthing babies are different.  It is difficult to define, but there is a calmness and an alertness about them.  They have been observed to start to put on weight straight away, instead of losing weight for a few days while they recover from the traumatic experience of birth before beginning to put on weight and move forward again.  There are often reports that they are very calm babies who sleep through the night sooner.  As the children grow up, they take life easily in their stride and remain calm and happy.

Though women come to HypnoBirthing for a more comfortable birth, which time and time again it has been shown to deliver, in the long run the benefits for the baby are of even greater, and the  significance of this cannot be over-estimated.

Katharine Graves

 kghypnobirthing.com

PHE advises temporary suspension of heated home birthing pools filled in advance of labour in home settings.

Please be clear this alert is NOT for baths and birthing pools filled from domestic or hospital hot water systems then pumped out when cold/dirty or then going through normal plumbing. This IS for heater filter units which re-circulate warm water. This is not about these circulatory systems being innately dangerous either – just that the sanitzation and effectiveness of all units now have to be checked to ensure safety before being hired out or used. There is a potential for contamination if the unit is not fully disinfected, or the unit is not working properly or the users do not follow the strict instructions. Investigation is under way. So if you have one, lend one, or hire one, then contact your local Health and Safety Dept at your local authority to get advice on ensuring this awful situation does not happen to you, a loved one, or a customer.

 Every good wish

Ruth@Aquabirths

 https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby

Press Release Text:

Public Health England (PHE) and NHS England have temporarily advised against the home use of birthing pools with built-in heaters and recirculation pumps, potentially filled up to 2 weeks in advance of the birth. This follows a single case of Legionnaires’ disease identified in a baby born in this specific type of birthing pool at home. The baby is currently receiving intensive care treatment in hospital.

Samples taken from the heated birthing pool used have confirmed the presence of legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to establish if it is the same strain which infected the baby. This is the first reported case of Legionnaires’ disease linked to a birthing pool in England, although there have been 2 cases reported internationally some years ago.

NHS England has today issued a Patient Safety Alert rapidly notifying the healthcare system – and specifically midwives – to the possible risks associated with the use of these heated birthing pools at home. The alert recommends that heated birthing pools, filled in advance of labour and where the temperature is maintained by use of a heater and pump, are not used for labour or birth. In the meantime, a full risk assessment into their use is being carried out.

The majority of birthing pools used at home are filled from domestic hot water systems at the time of labour – these birthing pools do not pose the same risk and are excluded from this alert. There are no concerns about these types of pools as long as pumps are used solely to empty the pool and not for recirculation of warm water.

Professor Nick Phin, PHE’s head of Legionnaires’ disease, said:

This is an extremely unusual situation, which we are taking very seriously. As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available.

We do not have concerns about purchased or hired pools that are filled from domestic hot water supplies at the onset of labour, provided that any pumps are used solely for pool emptying.

PHE and relevant local authorities are investigating the infection control measures required for this type of birthing pool and local authorities will be working with the small number of companies who supply these heated birthing pools for use at home.

Louise Silverton, director for midwifery at the Royal College of Midwives, said:

Women planning birth at home using a traditional pool that is filled when the woman is in labour or using a fixed pool in an NHS unit are not affected by this alert and should not be concerned. Birthing pools in hospitals are subject to stringent infection control procedures and monitoring. Home birthing pools filled during labour come with disposable liners and are only in place for a relatively short time period, reducing opportunity for bacterial growth.

Any women with concerns about using home birthing pools should contact their midwife or local maternity unit.

Legionnaires’ disease is extremely rare in childhood, with only 1 case in children aged 0 to 9 years reported in England between 1990 to 2011.The infection does not spread from person-to-person – people become infected with the bacteria through inhalation of contaminated water droplets.

BMJ article on bedsharing uses old data and shows bias.

After the BMJ article with the attendant publicity, that bedsharing is dangerous for all babies, this refreshing response from the Durham University Sleep Lab and the Helen Ball team provides a strong critique

Carpenteretal2013ISIScommentary1 2

Two short exerts from the article:

The authors draw particular attention to the situation for breastfed infants of nonsmoking
parents in the absence of alcohol consumption according to whether the
infant slept in a cot in the parental room or in the parental bed (1st row in the above
table). They predict a SIDS-rate of approximately 1 per 10,000 babies for the
former group, and 2 per 10,000 babies for the latter. The current rate of SIDS in UK
is 1/3000, or 3.4/10,000, which means that both sleep locations for breastfed
infants of non-smoking parents in the absence of alcohol experience very few SIDS
deaths. It is curious, therefore, that the authors issued a press release to call
attention only to this small difference in predicted SIDS rates for breastfed babies of
non-smoking parents who bed-share compared to room-sharing–while ignoring
the hugely inflated risks associated with hazardous bed-sharing environments. It
appears as though the authors choose to target breastfeeding mothers in this way
as they are a sub-group with strong opinions about the benefits of bed-sharing,
even though the infants of these mothers contribute negligibly to UK SIDS rates.

They also say:
” it is important to be aware that the data upon which these analyses are based are now 15-26 years old (although referred to as ‘recent’), and have been compiled ad hoc from a heterogeneous
collection of studies performed in different countries at different time points, using different methods and definitions for data collection (i.e. it is based upon data that
are neither comprehensive nor systematic). It can therefore provide only weak evidence for informing public health policy, and parental infant care behaviour in 2013

 

For the Unicef response, follow this link:

http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-statement-on-new-bed-sharing-research/

 

Previous Older Entries