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birth plan, pregnancy

Entonox/ Gas & Air – birthing pain relief

Gas & Air is a very popular form of pain relief for supporting women in labour and many women report excellent satisfaction with its use!

It is a mixture of oxygen and a gas called nitrous oxide, and it is breathed in through a mouthpiece.

There are a couple of really handy and vital facts to know about gas & air, which make a big difference to its effective use. The gas is breathed in for the contraction only and you stop using it and rest in between the contractions. These are my handy hints I prepare clients as well as birth partners with….

Firstly, as it is a gas and you use a mouthpiece to breathe it is – it can make your mouth feel very dry. If you anticipate this and have sips of water to hand, this can help in the initial stages.

Secondly, the pain relieving effect of the gas is slightly delayed after 10-20 seconds of use, so women need to start breathing it is as soon as a contraction begins – this way the full effect happens by the time the contraction reaches its peak. There too is a slight delay in it wearing off for 10-20 seconds after stopping it.

Thirdly, the gas can increase a nausea feeling, especially in the first few contractions of use, and this can be quite unpleasant and frankly undesired. I encourage women to anticipate this and push past the nausea as it often soon settles once you become established in using the gas effectively.

Fourthly, entonox does not remove the pain of labour completely – it simply is a tool/aid for helping to support you by making you feel a little “removed” from reality during the contraction.

Fifthly, I encourage clients to push past the initial challenges of how the entonox makes you feel, and usually quickly, within around 10 minutes of using with regular contractions, it becomes your new best friend! The role of your birth support partner is vital in “cheer leading” you along at these stages!

It is also useful if the midwife or Doctor needs to examine you and you are feeling uncomfortable or anxious, as well as other times, for example when you are have stitching post birth. Its a good “pick me up”!

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Anaemia in pregnancy

Anaemia in pregnancy can commonly develop due to the demands of the growing pregnancy, and can be caused by a deficiency of iron in the diet.

Pregnant mothers are tested (blood test) usually at booking and again around 28 weeks of pregnancy, and these levels are used to shape care and advice.

Symptoms of anaemia can include tiredness and paleness of colour – breathlessness too on exercise – but essentially it can be common to feel tired in pregnancy due to the demands on the body so a chat with your midwife or GP to talk through any concerns you have is important.

Diet plays a key part – that saying “we are what we eat” is oh so true!

For my clients I always take a thorough history as well as review of blood tests results, and take the time to discuss in detail their diet – such as number of meals a day, home cooked meals from ingredients as fresh/ close to the source, food restrictions or avoidances, choices and intolerances.

If you eat very healthily and enjoy a full range of foods then supplements may not be necessary. I counsel women too regarding maximising the absorbency of iron from their diet/supplements if they are required. One simple trick is to increase vitamin C intake as this has been shown to improve the absorbency of iron.

If iron supplements are required it is important to have a repeat blood test 2 weeks after commencing the supplement, to ensure that the iron levels are improving.

I also counsel women regarding the unpleasant side effects of iron as these can come as a surprise, and deter women from continuing with the iron. It is important to find an iron supplement that “suits you” so if clients struggle with one type, I recommend another to try until one is found that is tolerable.

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Testimonials

It is impossible to explain how much Helen has helped us. I credit her with my positive pregnancy, birth and parenting experience to date. Her support has made a phenomenal difference for our family. She helped us make informed choices as pregnancy progressed – everyone commented how calm I seemed and I think this contributed hugely to a relaxed straightforward labour. Having a relationship with your midwife helps immensely and it is a real shame this isn’t the normal procedure.
Helen was a mentor, a friend and when necessary ensured i got the old-fashioned straight talking I needed to get through labour! When we had early issues with breastfeeding Helen was fantastic and without her support I’m sure I wouldn’t have been able to continue. We were also impressed she supported us as a family and included my husband. I would not have another child without her support and recommend her services to everyone.
” Jan 2019

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Epidural in labour

A recent article in the Sunday Telegraph (https://www.telegraph.co.uk/news/2020/01/25/women-labour-denied-epidurals-nhs-amid-concern-cult-natural/) suggested that women are being denied an epidural in labour.

As an experienced midwife, I can only see that comments such as these will scare monger women, who after carefully researching all methods of pain, have made an informed decision to choose an epidural for pain relief in labour.

When I support clients for their births, yes I see the NHS is stretched and staff are over challenged by sheer volume of work, but I see staff – midwives, obstetricians and anaesthetists, listening to women and their requests and choices for pain relief, and providing that care within a safe framework. Yes sometimes client’s have had to “wait” for their epidural as there is an emergency on Labour Ward – but I witness good support in the meantime whilst they have to wait etc. So I seek to reassure that it is unlikely that you will be refused or denied an epidural, if requested. All pregnant women need to be mindful that of course sometimes all the best laid birth plans can be over ruled by Mother Nature though!

This is a balanced article written by an Anaesthetist you may find helpful to read!

https://www.rcoa.ac.uk/blog/epidural-denial-thoughts-frontline

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Dr Bill Franklin “grandfather of allergy”

Dr Bill Franklin recently celebrated his 107th birthday and as an expert in allergies, was asked what practical steps parents could take to protect their children from allergies.

He highlighted that genetics plays a part in around 30% of allergies but that 70% are due to the environment.

He talked about parents smoking and whether the family live near a road and therefore the children breath in pollution.

But he also highlighted the importance of breast feeding as well as vaginal birthing, where clinically possible. There is increasing research into the importance of the newborn baby passing through the vagina/birth canal, and picking up on important bacteria – we call this the seeding of the newborn microbiome.

Both breast feeding and vaginal birth helps to properly prime the newborn baby’s immune system.

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Exercise in pregnancy

I am often asked about this!

It really is a good idea to keep moving, even at term of pregnancy! It is very tempting to sit back and “rest” when you feel heavy and uncomfortable, but a gentle walk every day for around 45 minutes will help you, and your general wellbeing – both mentally and physically!

Pregnancy hormones can cause your  joints to relax a little (in preparation for labouring), especially towards the end of pregnancy, so go easy – no crazy workouts!

Swimming is an ideal exercise, as the water supports you well.

It is quite common to get a little increased breathlessness when exercising, due to the weight of pregnancy etc. If you have any concerns do speak with your midwife or GP.

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Apgar scores

So I have learnt something new today as a midwife….about the Doctor who invented Apgar scores – a score/tool used by us midwives/ doctors all over the world for assessing/recording a newborn’s condition at birth. “Google Doodle” today celebrates the 109th birthday of Dr Virginia Apgar – the doctor who devised the Apgar score. Its a score that we give newborns at 1minute, 5 minutes and 10 minutes after birth, assessing heartrate, breathing, colour, muscle tone and neurological reflexes. Clever lady! Incredible that her assessment score is still today used as a standardised assessment tool at birth for the wellbeing of the newborn!

Dr. Virginia Apgar’s 109th Birthday

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Continuity of care

I have been super busy since new Professional Indemnity Insurance has facilitated a return to the full Independent Midwifery services that I can offer clients again.
Supported several clients for their births in recent weeks, and lots of new bookings for births due over the coming months. Been truly privileged to support returning clients – having now provided care for their first pregnancy, birth and postnatal, and now second! Adds a terrific dimension to continuity of care!

A text from a new Dad client following the support I provided them as a couple for their birth.

Finding my work very rewarding.

text 2018

new mum

Maternity Leave

Several of my antenatal clients have chatted with me during their antenatal appointments this week re maternity leave, and how long to take etc. Read an article yesterday which quite surprised me!
I quote (no idea re source for this data)…..
“1:4 women in the USA take just 2 weeks off after giving birth” and it stated that a former Yahoo CEO took just a fortnights leave after having her twins! My she must have had a very robust support around her to achieve that!
My thoughts though were also towards the newborn babies….feeding and establishing of it generally takes a couple of weeks at least.
It quite simply is not long enough off following the birth – for new mother recovering postbirth and newborn baby/babies.
Maternity Leave needs to be longer than that ideally!