Delayed Cord Cutting

This is an interesting article of how delayed cord cutting can help your baby.  I am a great proponent of allowing the cord to stop pulsating before it is cut.

http://www.dailymail.co.uk/health/article-2062041/How-delay-cutting-cord-help-baby.html

Skin to Skin

As midwives we promote skin to skin contact with your newborn baby.  If all is well we birth your baby onto your abdomen from birth.  This helps your newborn baby to adapt to life outside the womb where the umbilical cord (iho) is sending a rich blood supply from the placenta (whenua) to your newborn baby.  It helps with temperature control, if you are feeling shivery from the hard work of labour your baby will warm you up and vice versa.

Secondly, it helps promote breastfeeding, your baby will go to the breast and even if he/she does not latch straight away the benefits of skin to skin is phenomenal, even for premature babies.  If you do not know already, I am a great proponent of the love hormone :-) oxytocin, this  is what I call the 'falling in love' hormone.  

There is an invisible feedback mechanism between you and your newborn baby that you cannot see but goes on nevertheless.  You are falling in love with your newborn baby that you cannot put him down, we call this 'bonding.'  Oxytocin triggers the let down reflex when your baby goes to the breast and at the same time, it contracts your uterus to help the placenta expel itself.  I will discuss lotus births in another article but for now, I will keep to skin to skin.  

There is also good evidence for delayed cord cutting at birth until the cord (iho) has stopped pulsating.  This is because your baby is still receiving a rich source of iron, oxygen and nutrients that help your baby to adapt to his/her new world.

Speak to you midwife about skin to skin contact.

http://www.breastfeedingonline.com/Skintoskinpdf.pdf 

Updated information area

I have updated the information area on our website

www.marieandmaureen.co.nz

I am adding various articles which I will ensure are on my blog and the website.

New website

What a beautiful day in Whangarei!  What a busy week with setting up not one BUT two new websites!  I will have to design websites for a living.  


www.marieandmaureen.co.nz

Because two other midwives will be joining us in our lovely new offices on Otaika Road, I have set up the Otaika Road Midwives website which is under construction but I thought I would introduce Melissa and Sue.  Some of my ladies will know Melissa, as she covered me when I went to England in July (thank you Melissa) and Sue, who used to be a Whangarei Team midwife but is now coming out as an independent.  Kia ora guys.


www.otaikaroadmidwives.com

A very exciting time for us

Hi everyone,


It has been a very busy time for myself and Maureen.  We have been using every spare moment to set up our new website www.marieandmaureen.co.nz  AND moving into our new premises at 
87 Otaika Road, Whangarei. 


It is very exciting to have new offices and right opposite the tourist centre in Whangarei, for any pregnant tourists out there :-), actually the food is pretty tasty, so very convenient just nipping across the road for a tea and veggie slice.

Our new website

Maureen and I have  new website and have been busy setting it up.  I love a challenge and designing your own website is certainly one of them :-)


www.marieandmaureen.co.nz

My new midwifery partner

WOW!  Where does a month go?  We are nearly at the end of September and Spring is here.  I am so pleased that I have a new midwifery partner Maureen (please see our web site www.mariethemidwife.net introducing her).  Maureen is a very experienced midwife who, until recently worked at Whangarei hospital.  We share the same philosophies and both of us are passionate about our love of midwifery and working for the family/whanau. 

We will both be contributing articles to the blog as we go along.  That will make up for the last couple of months when it has been really busy for me that I have been unable to get a blog written

:-)  

Pregnancy Art and Belly Casting

 I love looking at spiritual art, especially when it depicts the sacred art of birth and motherhood.    The mother and her unborn baby have a unique connection which develops as both journey through life together.  

I came across these lovely pictures while searching the internet, you can go to see the full gallery from the link below the pictures.

http://www.etsy.com/shop/kmberggren

Belly casting

I wish belly casting had been around when I was pregnant with my kids.  I think belly casting is a great idea and what a wonderful thing to keep for when the children get older :-) 

I have pasted a couple of examples here, follow the link for more information if you are interested.

http://www.paperbelly.co.nz/

Laughing gas for ladies in labour

I came across this article and thought ladies  may be interested :  the UK and NZ have been using entonox/nitronox for quite some decades and it is a good form of pain relief.  It is news to me that it is not used in the United States, ah, I see that it is used in Canada.  Any US midwives reading this blog?

Laughing gas for ladies in labor

Posted by Maggie Koerth-Baker on Tuesday, May 24th at 9:33am

Apparently, nitrous oxide—the stuff they give you at the dentist—is a safe anesthetic to use on women who are giving birth. Pretty surprising to this American. I've always generally had the impression that gas was dangerous for pregnant ladies—in fact, I've had dentists who wouldn't let pregnant nurses administer nitrous to me. But the case made in this Slate article by Libby Copeland sounds well-supported by evidence. Even more interesting, none of this is likely to raise eyebrows in Europe, where lots of women have used nitrous during labor for decades.

So why isn't this normal in America? From the sounds of things, it's a combination of a difference in mid-century medical culture, and some really bad timing.

The gas was first used on laboring moms in the 1880s and came into more widespread use in the 1930s, when a series of technical advances in Great Britain made it easier for laboring women to self-administer through a mask. Nitrous is still used widely in other countries' delivery rooms: According to data parsed by nurse-midwife and former Centers for Disease Control and Prevention epidemiologist Judith Rooks, well over half of laboring women sampled in the United Kingdom use nitrous oxide today. In other places, including Finland and the Canadian province of British Columbia, close to half of women use it.

Why don't we have it here? As the Associated Press has reported, only a handful of American hospital delivery rooms still offer nitrous to laboring women. It was more widely available in this country from the '30s through the '50s, says pediatrician Mark Sloan, author of Birth Day, but several factors blunted its popularity. For some reason, Sloan says, the idea of women self-administering nitrous oxide didn't catch on here the way it did in England, where midwives started towing nitrous around with them to home births. In the United States, by contrast, hospital deliveries were the norm, and doctors and nurses were told to deliver nitrous by holding a mask over a laboring woman's face with each contraction. When, in the '50s and '60s two rival inhalational anesthetics came along, both of them less time-consuming to administer, they elbowed nitrous oxide out of the way. It later turned out these rivals were dangerous, but just when nitrous might have been poised to make a comeback, the epidural arrived on the scene.

Copeland points out that, unlike an epidural, nitrous doesn't so much eliminate pain as make you not really care that pain is happening. That rings true for me. Personally, I credit nitrous with getting me over a paralyzing fear of needles. Back in junior high, I once panicked and tried to run during an MMR booster, and nearly got the needle broken off in my arm. But in college, when I faced my first cavities, my then-dentist suggested nitrous. I still felt the shot. But I didn't feel the terror, and the nitrous made the pain of the shot seem like not such a big deal. Today, when I get a cavity, I don't even use the gas any more. I'm still probably more anxious about shots than the average person, but the gas really helped me break down the mental block I had, so I can actually get the medical treatment I need now.

I doubt shots are really a good metaphor for the pain of childbirth, but the pain of childbirth certainly is scary to a lot of women. If you don't think you want an epidural, but do want something to take the edge off, nitrous does sound like it could be a nice third option—somewhere between toughing it out and using effective painkillers that have the unfortunate side-effect of preventing you from walking around or peeing on your own. Women are different, and have different needs. It would be nice if they had more than two ways to deal with labor pain.

http://boingboing.net/2011/05/24/laughing-gas-for-lad.html

Back in New Zealand

We are now back in beautiful New Zealand after a wonderful time away.  Weather was absolutely beautiful abroad and where the temperatures were in the high 30 degrees, came back to Auckland where it was the coldest day for 16 years :-) Ah well, it will soon be Spring and where the earth begins to warm, perfect bliss.

Seeing my Grandson

I am in England at the moment visiting my wonderful family.  My Grandson, Luke is just beautiful, well done to Graham and Sophie and to my daughter Lynda and her partner, Gary.  The weather is just perfect, which is a bonus for England :-)

Darkening of the skin in pregnancy

This is very common in pregnancy.  Skin darkening is caused by the effects of your hormones stimulating melanocytes production which causes pigmentation patches on the skin.  On the face, it is called Chloasma and used to be called the 'mask of pregnancy.'   Freckles, scars, and areas on your face can darken.  On the abdomen it is called the linea nigra where a dark line develops from the umbilicus down to the pubis area.  The arerola (dark area) of the breasts will also darken.

It does not harm you in any way and usually disappears several months after you have your baby.

Will I get stretch marks?
A common question that women ask.  Striae gavidarum or stretch marks occur usually on the breasts, abdomen and thighs of the pregnant woman. Unfortunately, what is not known is what women will get them and what women will not.  Stretch marks are caused by the elastic collagen tissue under the skin stretching and tearing and forming red stripes over the abdomen.


The good news is that after you have the baby, the marks will fade and eventually becomes faint silvery lines, although unfortunately the skin texture will always be there. 

I have been trying to find some online research about the use of olive oil/cocoa butter etc., helping to reduce the risk of stretch marks but no evidence has proven conclusive.  Vitamin E is a vitamin that is found in certain skin pregnancy products and is said to help with the repair scar tissue.  Here is a link to a website that explains stretch marks, they also give a list of foods that contains vitamin E. 

http://www.allaboutstretchmarks.com/VitaminE.htm 



http://health.howstuffworks.com/skin-care/problems/medical/melasma.htm

Midwifery Quotes

For Midwives and Mums the world over.  I love searching the internet to find some inspirational quotes to use, not only for midwives but also for mums and mums to be. 

These I found from the "Birthing without fear" website.

                    

     "Giving birth should be your greatest achievement not your greatest fear."
- Jane Weideman

     "We’ve put birth in the same category with illness and disease and it’s never belonged here. Birth is naturally safe, but we’ve allowed it to be taken over by the medical community."
Carla Hartley, founder of Trust Birth and the Ancient Midwifery Institute

 I love this one, we have this quote on the front of our induction diary on delivery suite
:-)  

     "Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn’t dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line."
~ Gloria Lemay

"The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power. "
~ Heather McCue

This is another quote that I just love and I feel humbled at the strength of women. 

 

     "You are a midwife, assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves!”
- From The Tao Te Ching

     "Women’s strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers."
-Annie Kennedy & Penny Simkin

a link to where I got these quotes.

http://birthbuddy.wordpress.com/resources/quotes/ 

Blogger - where is my article?

Blogger went down for a long time yesterday, when it came up to I cannot see the article I put up on the 10th May.

Since I cannot contact Blogger, it appears the article has been lost forever.  My apologies to anyone who cannot find the article from my facebook link.  My fault for not saving the article to my hard drive instead of relying on blogger to autosave.

Lesson learned. 

Witches, Wise Women and Midwives

I have always been interested in the history of midwifery, what happened to the midwife or wise woman as she was known, the hedgerow healer whose knowledge of herbs and healing was profound. She tended to administer to the poor and treated everyone from cradle to grave.

Her knowledge was handed down to her apprenctice by word of mouth, rather than the written word because she was usually illiterate.  Many of my sister's were persecuted, tortured and accused of witchcraft.  They, along with many other innocent men, women and children were drowned or burned at the stake, simply because they had knowledge of effective herbal remedies. 

These valuable herbal remedies were lost forever if she was unable to pass her information on to her apprentice.  Those centuries became known as the "Burning Times."   

The Malleus Maleficarum was a treatise first published in 1487 in Germany, the authors of this 'guide' belonged to the Inquisitors who worked for the Catholic Church accused midwives of infanticide, cannabolism, making men impotent and, as women were weak in faith they were susceptible to the devils temptations.  They ordained that only "men could heal" and, that the worst of all was the "midwife."

These were times of great hysteria and fear, people would accuse their neighbour, relative, some elderly lady who owned a cat to get the witchfinders or inquisitors off their back.  Those wise women who escaped the inquisitors had to either stop practising herbal lore for fear of being found out, they left to go to another part of the country where there were no iinquisitors or, at great risk to themselves, they continued their practice underground.  

     "By changing men into beasts by their magic, procuring abortions, offering children to the devils, besides other animals and fruits of the earth with which they work much harm." 
                                                                                                          (Malleus Malificarum, 1487)

The male doctor entered the domain of the female.  


References
http://en.wikipedia.org/wiki/Malleus_Maleficarum


Ehrenreich, B., English, D.  (2010).  Witches, Midwives and Nurses (2nd ed).  New York:Feminist Press

Why is my baby jaundiced?

Physiological Jaundice
Most healthy newborn babies become jaundiced (yellow) around about day three or day four, we call it physiological jaundice. It usually appears on the face and trunk of your baby's body. The reason for this, is because your baby is now breathing air and no longer requires the excess red blood cells that (carries oxygenated blood) he needed while he was in your womb.  The baby's liver begins to break down those excess blood cells and the jaundice manifests itself through the skin in the form of a yellow pigment.  The jaundice begins to fade gradually over a period of 10 days and does not cause any harm.  

The advice we give is to let your baby feed at the breast for as long as he wants, that way the sufficient quantities of breastmilk will help your baby eliminate the jaundice from his body.  

Breast milk Jaundice
Some babies can develop breastmilk jaundice which is not harmful, in fact, breast milk jaundice can develop later than 10 days after birth and continue for as long as two to three months.  The cause of breast milk jaundice is not known and there is no reason why breast feeding should be discontinued. If the jaundice persists beyond two weeks, your midwife may do a blood test to check your baby's bilirubin levels and seek the advice from a paediatrician.

When should you be concerned?
With the exception of breast milk jaundice, in the case of physiological jaundice, the jaundice will gradually fade and disappear around 10 days.  Your baby will remain alert when awake and breast feed on demand.  A healthy newborn baby will gain weight and have at least six wet nappies in 24 hours, although it will be difficult to tell if your baby has a wet nappy if he has opened his/her bowels.  Your baby's stools will change colour from the thick black meconium (produced for the first three days) becoming lighter, and usually by the third or fourth day are a yellow/brown colour.


If the jaundice (yellow colouration) becomes deeper and covers more of the baby's skin or white (sclera) of the eyes become yellow and your baby's behaviour changes from being very alert as he was in the first few days, to becoming sleepy and not very interested in feeding, it is important that you seek advice from your midwife.  Your midwife can perform a blood test on your baby that records the serum bilirubin (yellow pigment) in the blood and its a way to check if your baby requires treatment.


If your baby becomes jaundiced within 24 hours of birth, you must inform your midwife immediately.
Always seek the advice from your midwife or well child provider if you have any concerns about your baby.


http://www.lalecheleague.org.nz/resources/15/231

I hope Le Leche wont mind that I took this picture from their website, just thought it was awesome :-)

I am a new Nana

Thank you to Graham and Sophie for making me a very proud Nana and to gorgeous baby Luke :-) I am so filled with love for you all and to my daughter Lynda, for keeping me updated.  We cant wait to see you all.xxxxx

Ouch - Sore nipples

Having a baby can often be very tiring and when you are tired it is even more important to ensure that your baby is correctly positioned and latched at the breast to prevent sore nipples.  Breastfeeding is the best thing you can do for your baby and for first time mums and also mums who are breastfeeding for the first time, it can be pretty tough going for the first week to ten days when breastfeeding is becoming established.

Firslty, your comfort is important.  If you are comfortable and relaxed then it will be easier for you.  Pillows or cushions to support your back when feeding, some mums use a pillow under their baby when he/she is laying across the abdomen. Or, you can use a pillow when feeding in the 'rugby ball' position.  It is entirely upto you what position you chose, the main thing is your comfort.  When you are going to feed, have your water/juice close to hand so you can drink while baby is feeding and it is good for you to drink at least one glass an hour (when awake) as breastfeeding can make you quite thirsty.


Correct positioning

• Tummy to tummy.  In other words your baby's tummy towards your tummy.
• Baby's mouth at the same level as your breast, so baby is not trying to reach up to the breast or turn his neck trying to get there.
• Your baby's body is curled around your body like a banana.
• If your breasts are large, you can use a rolled up flannel under your breast to raise it up slightly.

 Correct latching

• Nose to hose.  Your baby's nose aimed towards your nipple.  This encourages him/her to open their mouth wide, very similar to a baby bird in the nest, who is waiting with a wide open beak for mummy bird to put the food in its mouth.
• When you see your baby's mouth open wide, then you can latch your baby onto the dark area of the breast (areola) and not the nipple.  

We do not recommend that you detach your baby, however, if there is sorness and pain when your baby feeds, he may not be on properly, in which case, use a clean little finger (short nails) inbetween his gums and break that suction.  Never ever pull a baby off the nipple - OUCH! Their jaws are very powerful and pulling your baby off can cause more pain and damage.  Do not be afraid to break that suction and detach him if you are hurting.

Mums ask about nipple balms.  Some of them can be soothing initially but the best thing to do is ensure that baby is latched correctly. You can expose your nipples to the air to airdry and sooth and you can also use some of your colostrum on the affected area to help heal.  

You are just awesome and we are here to help and support you as you go through your journey.

Seek the advice from your midwife/lactation consultant or breastfeeding support group.   This link has some great articles and advice.  We are very lucky at Whangarei hospital because we have a lactation consultant and educators, along with a drop-in breastfeeding support centre. 

http://www.lalecheleague.org.nz/resources/15/231 

A labour drink

Curtesy of Nicole who very kindly sent me this energising labour drink.  Thank you Nicole :-)

 1/4 cup honey
1 teaspoon salt
1/3 cup lemon juice
1 crushed calcium tablet

1 Litre of water

Anecdotically, calcium is said to help with the pain of labour, although I have not actually researched this.    

Blast from the past

I came across this early 1960's parenting book called "Modern Mothercraft" and thought I would share it with you.

"Time at the breast


     The time required for the average baby will be between ten to twenty minutes.  Both breasts should be offered at each feeding.  Ten minutes on both breasts, or ten minutes on the first and five minutes on the second, may be required, but babies do not take the same amount of breast milk at every feed, nor will the same amount be available in the breasts at each nursing, because there is more milk present in the early morning than later in the day.


     It is important to make sure that baby sucks well at the breast and that he does not dawdle, play or go to sleep.  The actual sucking time should not exceed 30 minutes."  


Well, at least they mention that it is important to make sure that baby sucks well at the breast.  Thank heavens that we no longer give this advice and the evidence suggests that, letting your baby feed when he/she wants for as long as they want will stimulate the release of the hormone prolactin which builds up the milk supply.  

Your baby will comfort suck and play at your breast, the eye contact and hormonal feedback mechanism between you and your baby is phenomenal.  It is the same hormones that are released when you fall in love, you and your baby are falling in love, we call it bonding.  Your baby is helping you fall in love with him that you cannot put him down because he is dependent on you for survival.  I tell mums that babes require three things, food, warmth and love.  Breast feeding and mummy and daddy give baby all three.


     Royal New Zealand Society for the Health of Women and Children (incorporated) Plunket Society.  (1964).  Modern Mothercraft.  Coulls Somerville:Dunedin.

Chit Chat

Had a wonderful home/water birth last week.  We used my new birthing pool for the first time and I have to say it was excellent.  I have two birthing pools, one where you have to put the frame together, then feed the outer liner through it and then the inner liner.  It was a great pool but fiddly to put together and there was no padding on the floor of the pool, which meant that knees got sore, or I put heaps of pillows inbetween the two liners.  

My  new one has an inflatable floor so knees are cushioned well and its walls are sturdy enough for someone to sit on.  Yes, I am very pleased with my new pool.

Patterns, schedules and breastfeeding your new baby.

Congratulations for choosing to breastfeed your baby, it is the best thing you can do.  As a midwife I am oftened asked when babies sleep through the night or, parents tell me that they were up all night feeding their baby.

Baby Behaviour
I think it would be great for our daughters to know how wonderful breastfeeding is and, that night feeds are really important. Babies do not read the book that say adults sleep at night, also, if I took that sandwich out of your hand and said you cant eat it until later or, tell you that you cannot have that snack you are looking forward to having. I am sure you would not be very happy with me, in fact, you would probably tell me, in no uncertain terms what I could do with myself.  

Babies do cry, it sounds obvious but they cry for many reasons, hunger is one, but also because they want our warmth and comfort, they are having a growth spurt, they are wet, dirty, bored or, they cry simply because they can and want to be held.  Speaking from experience both as mother and a midwife, I find it very interesting (and funny too) that we, as humans, expect our offspring to go into a different room, cot, away from us to sleep etc., when, in the animal world their young are continually clinging to their mothers for protection and, where there is free access to the breast.


Free Access Feeding
So, why do we think babies should be any different and conform to patterns and schedules?  Babies are like any other mammal, they seek out the warmth and protection from their mother and suckle at the breast. All mammals in the Kingdom allow what I call 'Free Access' feeding, in other words, letting your baby feed from the breast, whenever he/she wants for as long as they want. I do not call it 'demand' feeding, because it sounds like your baby is being demanding, when in actual fact, they are displaying normal behaviour and doing what any other mammal would do. 

By giving your baby 'Free access' to the breast, it stimulates the release of a hormone called prolactin to help build up your milk supply and, baby gets a nutritious drink at the same time. Prolactin, is mainly released at night, released during the day to a certain extent but mainly at night, that is why night feeds are important.  

Growth Spurts
Your baby will have a growth spurts, usually every one to two weeks and will want to go to your breast quite frequently for 24-48hrs because he/she has put on weight and needs to increase your milk supply, and he/she can only increase your supply by sucking frequently at your breasts. 

Do not expect any set patterns for a while because it takes at least 7-10 days to get breastfeeding established.  Some advice to get you through the early weeks are to ensure that you get adequate rest, is for you and your partner to sleep while your baby sleeps.  Do not feel that you have to entertain visitors, dust and housework can wait, in fact, organise a good friend/relative to come in to do some housework for an hour or so a day.  

KNOW THAT YOU CAN DO IT.....have the confidence to know that you will produce more than enough milk for your baby, if you allow 'Free Access' feeding to your breasts.  You are just awesome and we totally support you in mind and spirit. 

Some organisations (apart from your midwife) that are just wonderful with help, support and advice are your local Lactation Consultants and the La Leche league. 

http://www.lalecheleague.org.nz/
http://www.midwife.org.nz/index.cfm/1,78,0,0,html/For-Women

All in a day

You know this evening, I was thinking how wonderful and varied my work is.  In fact, I do not call it work, I actually call it a privilege.  To be the midwife chosen to share and participate in the care of the woman and her family makes it very special.

I can be on the road going from house to house doing antenatal checks and meeting the family one minute and then rushing off to delivery suite to birth a baby the next.  Then, if it is still early in the day, maybe do some more antenatal or postnatal checks on mums and babies.
 
I consider myself very lucky and I am humbled at the amazing inner strength of women as I share their journey with them as they go through their pregnancy, birth and grow into motherhood.  

The lifestyle can be unpredictable, in the sense that I can be anywhere at any given time, that said, I would not change that for the world.  Thank you for allowing me to share your journey.

Partners in the birthing room

I am going to talk about men.  Not men in the general sense but those who are planning to be present at the birth of their baby.  Usually sometime after the birth, I chat to the men to see how they got on when their partners were in labour and their thoughts and feelings on the process.

To give a sense of history, men have only been invited into the delivery room for the last 35 years.  Before then, when woman went to hospital to birth the baby, traditionally the men would have been sent home and told to come back the following day, or they were sent to waiting room where they would either chain smoke or pace the corridor until they were told the baby had been born. 

The results of a study carried out by Bedford & Johnson (1988), found that, father's perceived their presence and role in the birthing room as one of guidance, comforting and protection from an alien enviroment. However, recent research suggest that fathers felt they were excluded from the decision making and were left feeling isolated and frightened (Harvey, 2010).




The main concern that came from the discussions were that men perceived themselves as not being able to do anything for their partner, particularly the pain.  To put this into perspective, pain is subjective and it means different things to different people. That said, the pain in labour that your partner will experience is completely normal, in fact, I call it 'Good Pain,' because it lets us know that the woman is in labour and her body is working hard for the baby to be born. The pain of labour also helps her body to release endorphins which are its own powerful morphinelike painkiller.  

There are many things that you can do to help your woman in labour.  You can be there to hold her hand, tell her you love her, massage her back, tell her you are proud of her, wipe her brow, support her through the pain by  telling her how wonderful she is.  Help her to remember to drink water between contractions, to breathe through the contractions, to connect with her baby.  You can be there to guard the doorway to prevent over excited relatives turning up unannounced and interupting the flow of her labour (unless she has invited them).  The Midwife will be there as advocate and support you both, she will explain everything fully so both of you are able to make informed decisions.  

While searching for a link for new fathers, I came across an article where a top obstetrician suggests that men should never be at the birth of their child.  Michel Odent, who I have quoted before (see Oxytocin the love hormone) in my blog, suggests that, "his presence is a hindrance and a significant factor why labours are longer, more painful and more likely to end in intervention."

Makes interesting reading, here is the link to the article.
http://www.dailymail.co.uk/femail/article-559913/A-obstetrician-men-NEVER-birth-chttp://fatherandchild.org.nz/hild.html


For fathers and their children
http://fatherandchild.org.nz/ 

Bedford, V.A., Johnson, N., (1988).  The role of the father. Midwifery. 4 (4). 190-195.
Harvey, M., (2010).  More support needed for new fathers in the delivery room.  
http://www.bcu.ac.uk/news-events/news/more-support-needed-for-new-fathers-in-the-delivery-room

Diet in pregnancy

The reason why it is important for you to have a good diet is, not only for you to feel healthy and well during pregnancy, but also for your growing baby.  

I thought I would list here the important vitamins and minerals and the food sources where they can be found.

Vitamin A (needed for bone and tissue growth, , healthy skin, eyes and mucous membranes)
Raw carrot, leafy green vegetables such as spinach, pumpkin seeds, parsley, celery, capsecum, cabbage, watercress, tomatoes.  Also found in fruit such as mango, papaya, oranges and dried apricots.

Vitamin B (For development of the nervous system and brain)
Also known as the complex vitamin and is found in leafly green vegetables, meat, yeast extract, egg yolk, fish, sweet potatoes, tomatoes, beansprouts, avocados, banana, nuts, mushrooms, currants and wholegrains.  


Vitamin C (For the immune system, tissue formation and helps with iron absorbtion and is depleted by smoking)
Found in red pepper, leafy freen vegetables, tomatoes, parsley, kiwi fruit, cherries, broccoli, papaya, strawberries, citrus fruit and melon.

Vitamin D (Needed for bones and teeth)
Also called the sunshine vitamin.  Spend 20 minutes a day in full spectrum sunlight. Also found in fish liver oil, salmon, egg yolk and butter.


Vitamin E (Needed for circulation, wound healing and tissue growth)
Found in dark green vegetables, broccoli, eggs, whole grain cereals, tomatoes, olive oil, nuts, pumpkin seeds, avocados and wheatgerm oil.


Vitamin K (Required for normal blood clotting)
Found in leafy green vegetables, kale, turnips, brussel sprouts, broccoli, spring onions, tomatoes, lettuce and asparagus.


Iodine (Thyroid function and energy levels)
Found in seaweed, kelp and iodinised salt.


Zinc (Immune function, nervous and skeletal system)
Found in green vegetables, lentils, almonds, tofu, rice, nuts, pumpkin seeds, whole grain, brewers yeast and oats.

Calcium (Needed for muscle contraction, brain function, involved in blood clotting).  Stored in the bones and found in leafy green vegetables, kale, almonds, chick peas, carrots, avocado's, brown rice, sardines and celery.


Iron (Needed to make oxygen carrying proteins and found in red blood cells)
To prevent anaemia, it is found in egg yolk, fish, meat, brewers yeast, kelp, sunflower seeds, pulses,lentils, oats and seaweed.

A friends sister used to make a wonderful nutritious energy drink for our labouring ladies and consisted of delicious lemon and honey, both of which are easily absorbed by the body. 

Thank you to Nicole who loaned me, "The Birthkeepers" by Veronika Sophia Robinson.  A wonderful book that helps us, as midwives, women, and mothers to remember our roots and to protect and reclaim the ancient tradition of birthing.  I have to say that I loved it and it totally resonated with me.

Donley, J., (2003).  Compendium for a healthy pregnancy and a normal birth.  Auckland.  
Robinson, V.S., (2008). The Birthkeepers:reclaiming an ancient tradition.  Starflower Press.

History of Midwifery - Why women died in childbirth

The history of midwifery has always fascinated me and especially those heroes and heroines who have tried to advance the profession of obstetrics and midwifery.

I am going to start with one hero in particular, Ignaz Semmelweis, a Hungarian physician working in Vienna.  It was Semmelweis, who in 1847 investigated the cause of puerperal sepsis or childbed fever among women attending the lying-in hospital.  He found that there was an increased death rate amongst women during childbirth who were attended by Doctors rather than midwives, who worked in another ward.  After conducting his own research, Semmelweis found that the cause of the sepsis was because physicians were not washing their hands between carrying out post-mortems and then attending women in childbirth.  Midwives did not attend postmortems so they were not to blame.  Semmelweis insisted that physicians attending his ward washed their hands with a chlorinated lime solution and, with this procedure enforced, he found that the death rate dropped considerably.

However, the medical fraternity dismissed Semmelweis' theory and refused to accept the blame for causing so much death.  As the germ theory had not yet been developed unfortunately the deaths continued, although Semmelweis continued to persue his theory, he was vilified from every corner of the medical profession and eventually suffered a nervous breakdown.  One comment made by an outraged physician to Semmelweis' theory was "A Doctor is a gentleman and a gentleman's hands are clean."  That would be funny if it were not so tragic, Semmelweis was committed to an insane asylum where he died in 1865.

By the end of the 19th century, the need for obstetric and midwifery hygiene and cleanliness was accepted by the medical profession.  The developement of antiseptic and discovery of antibiotics have greatly reduced the maternal mortality rate.

Further reading:
Pairman, S., Pincombe, J., Thorogood, C., Tracy, S.  (2006).  Midwifery preparation for  
     practice. Elsevier:Australia. 

http://en.wikipedia.org/wiki/Puerperal_fever 

Christchurch

My thoughts and prayers are with you all. 

My first waterbirth

In 1992 when I was a newly qualified midwife and just got my wings and gleaming new gold and blue Queen Charlotte’s medal to prove that I was now well and truly a midwife.  Waterbirths had begun to get notice in the press, not yet at the height of popularity but certainly being brought to the attention of women as an alternative option to birthing rather than the hospital delivery bed.  A woman and her partner had come to delivery suite with their birth plan and asked for a waterbirth.  The ‘old hand’ midwives on delivery suite who’s wisdom in years between them was phenomenal, however viewed waterbirths with somewhat suspicion, thinking it a ‘new age’ idea that would wear off.  

This labouring woman wanted her waterbith and was shown to the pool room.  However the midwives who were on duty had never dealt with them and were somewhat reluctant to participate or even understand why any woman could possibly want to birth in water.  Dolphins, fish and octopus are some of the words that spring to mind when I recall sitting amongst their discussion as to why women should birth on land and not in the water.  The midwives suddenly turned and looked at me and said “Marie, you're newly qualified, you know all this stuff, you can birth her.”   I smiled sweetly at them and said "of course" through my tightly gritted teeth.  As much as I read a lot of information on waterbirths and understood the theory behind it, I had never actually birthed a baby in water.  I left the pool filling while the excited but nervous parents waited patiently as I ran to where the text books were kept and pulled out the booklet on waterbirths.  I can tell you that I absorbed as much information as I could in the 20 minutes it took for the pool to fill and returned to the smiling parents with, as much of an air of serenity and calmness as I could muster.  Inside, my heart was beating like a drum, "you can do this Marie."

Full of confidence and hope and with my head full of wondrous knowledge, I returned to the lady who by now had got into the pool.  The list I had memorised from the book, continually churned in my mind :

• ·         Temperature must be checked every half an hour
• ·         Check temperature of the woman at the same time
• ·         Make sure the woman drinks lots of water due to the sauna effect
•          Hands off and let the baby come out into the water, Hands off, Hands off, Hands off AND REMEMBER hands off.

With those points in mind and butterflies in my tummy, I made sure that I followed the rules.  Every time I thought I should be doing something to the woman (as surely as any good midwife should), I left the room for a few moments to make the partner a drink or pretend to go to the loo, or if I ran out of excuses to leave the room, I sat on my hands, reciting the mantra I had learned, "hands off, hands off."  Just a little about task orientation, as nurses we tend to be task orientated to a certain extent, well we were back then where I trained in England and felt that if we are not doing anything to the client we are neglecting in our duties.  

Several hours later a little baby girl was born in the water, much to the joy of two very ecstatic parents and I have to say an overjoyed but relieved midwife who, I hasten to add, has never looked back since. I learned so much from that particular couple (thank you guys) who didn’t even realise it was my first (of many) waterbirths.  I also learned that midwifery is not theory alone and using four of our five senses, but our wonderful intuition and having faith in a woman and her ability to birth her baby.

Pain Relief in labour

Clients are often scared when it comes to pain in labour, and it is fear of the unknown for those of you expecting your first baby or, even a subsequent baby if the first time around was not a good experience for you.

I am not not going to lie to you, labour is painful but it is not pain that harms you in any way, in fact, it actually tells us your body and you are going through a completely normal physiological process.  

In early labour there are things you can do for yourself to help with the pain.  Rest and sleep in the early stages is important, to save your energy for later when the hard work begins.  You can also soak in the bath or sit on a plastic chair in the shower and let the warm water flow on your back (especially good for backache).  

In established labour
Walking around (being upright) helps gravity bring your baby's head down on your cervix (neck of the womb) to assist in dilatation. 

• You can get into the warm bath water (see my blog on Waterbirths to see how this helps with pain relief).  
• Having your support person massage your back can help to take that pressure off your back and help with pain.  
• Warm packs applied to your abdomen or back can help with the pain, a lot of women find a warm pack very helpful for backache in labour.

Endorphins
When you are in pain and provided you have had no pharmaceutical analgesia, your body will produce its own 'opiates' which are very similar to morphine but not as strong and act as a natural analgesia or pain killer.  The endorphins act on the sensory nerves that carries pain messages to the brain and prevents some of those messages being sent.  For those who have been privileged enough to be with a labouring woman, you will notice a change in her as she goes into her 'own space' as she goes between being awake and asleep.  Michel Odent, a French obstetrician suggests that these endorphins pass from mother to baby, providing 'pain relief' for the baby.


Gas and air or entonox
A combination of nitrous oxide and oxygen.  The labouring woman inhales the gas through a mouth piece at the start of a contraction alll the way through until the contraction finishes.  If the apparatus is used correctly it can provide good pain relief although, the effects of gas and air are short lasting as the woman exhales the gas from her lungs when the contraction has finished.   Side effects are that, for some women it can make them feel nauseous.  


Pethidine
Is a synthetic narcotic drug similar to morphine that is injected in to a vein or buttock during the first stage of labour. It can take 15-20 minutes to take effect and because it can make the woman feel sleepy and crosses the placental barriet, it can make baby sleepy too, so for this reason it is not given within 2-4 hours of birth.  Pethidine does not take the pain away, it sedates the woman to enable her sleep between contractions.
Side effects that it can make women feel sleepy, 'out of it' or 'high.' which some woman like and some do not, although until you actually have the drug, it is difficult to say how it will affect you.  It can make the woman feel nauseous or even vomit, in which case your midwife can give you something to reduce or stop this.  If the pethidine is given near the time your baby is born it can make your baby is sleepy and slow to breathe at birth, the midwife may have to give an antidote called narcan to your baby to reverse the effects of pethidine.  
It can take a few days before the pethidine is eliminated from your baby's body so your baby's may be quite sleepy and slow to suck at the breast.


Epidural
The anaesthetist sites the epidural which is an injection of local anaesthetic into the epidural space around the spinal cord.  Because there is a complete loss of sensation from the waist down, means that you will be confined to the bed.  Advantages are that it is a good form of pain relief although there are rare instances where the epidural block may not work or may partially work, in which case your midwife will contact the anaesthetist to come and check the epidural.

An intravenous drip with be sited in your hand or arm so fluids can be given to you through a vein - this is done as a precaution in case your blood pressure drops following the epidural.  You will be continuously monitored on a cardiotocograph, a machine that monitors your contractions and your baby's heart rate.  With your consent, a urinary catheter (tube into your bladder) will be inserted because you will not be able to feel the sensation of wanting to pass urine.
 
The disadvantages with epidurals are that, they can slow down your contractions so a hormone (oxytocin) drip may be needed to speed up your contractions again.  On rare occasions the dura or cover of the spinal cord may be punctured and cause leaking of spinal fluid and you develop headaches.  If this happens, there is a remedy and the midwife will ask the anaesthetist to see you.  An epidural relaxes the muscles of your pelvic floor and may lead to an instrumental (forceps or ventouse) delivery or even a caesarean section.  There can be some tenderness over the epidural site for some days following the birth of your baby.

Please chat with your midwife about the benefits and disadvantages of the types of pain relief and options available to you.


Here are some links :
Endorphins

http://primaljourneys.blogspot.com/2009/10/hormones-of-primal-birthing-endorphins.html
Pain relief in labour
http://www.kiwifamilies.co.nz/Topics/Birth/Pain+Relief+in+Labour.html
 

Vitamin K - What does it do and does my baby need it?

Parents often ask what Vitamin K does and does their baby need it? 

What does Vitamin K do?
Vitamin K plays a role in blood clotting and occurs naturally in the intestine where it is produced by bacteria.  We also get if from the food we eat, leafy green vegetables, alfalfa, whole grain cereals, cheese and milk.

 Why is it given to babies?
Newborn babies have less Vitamin K than adults although these levels increase during the first weeks of birth.  Why babies should have less Vitamin K is not known, there is speculation that the reason for the low level is to prevent clotting problems during birth (Wickham, 2001).  A newborn baby’s gut will not have the bacteria present to start Vitamin K production until they start to feed.

What is Vitamin K deficiency bleeding?
A small percentage of babies can have low level of Vitamin K in the blood which can lead to a bleeding disorder called Haemorrhagic Disease in the newborn.  Early Vitamin K deficiency bleeding occurs within 48 hours of birth and is rare.  It can be caused by certain medications taken by the mother during pregnancy which interfere with Vitamin K metabolism.   The most common form of Vitamin K deficiency bleeding occurs in the first week of life in healthy infants and caused by insufficient amount of Vitamin K in breast milk or a delay with breast feeding.  Vitamin K deficiency bleeding in the newborn is serious and can cause brain damage due to bleeding into the brain or even death.

What babies are more at risk?
It is not certain what baby will develop vitamin K deficiency bleeding but there are factors where the risk increases, eg., if the mother has had certain types of medication, babies who have problems absorbing food, birth injuries that have caused bruising and babies who are not breastfed from birth or not having sufficient quantities of colostrum.  The evidence suggests that colostrums and hind milk produce the richest source of vitamin. Giving your baby Vitamin K can prevent most cases of Vitamin K deficiency bleeding 

Vitamin K in breastmilk
Ensure that your baby is breastfed soon after birth and let your baby feed when he/she wants for as long as they want. This will ensure that they receive the vitamin K present in the colostrum and in the hind milk.  

How is it given to your baby?
Either by

·         By injection into baby’s thigh of a single dose of Vitamin K.

Or

·         By oral administration of three doses.  1^st dose given after birth of your baby.  The 2^nd dose is given at approximately one week of age and the 3^rd dose is given between 4-6 weeks of age.

Is vitamin K safe?

In the early 1990’s researchers suggested that there was in increased incidence of childhood leukaemia in infants who had received the injection of vitamin K and not from those who had received the oral vitamin K.  However, further studies in Europe found no increase of leukaemia or cancer in infants who received the injection of vitamin K, the UK department of health also found no association between childhood leukaemia or cancer with infants given the Vitamin K injection.  As with any injection there are risks associated.

It is your choice whether to give your baby Vitamin K, if you do decide your baby will be given Vitamin K, you have a choice of either the injection or drops.  Read about the benefits and the risks of Vitamin K with your midwife to help you make an informed decision.

Wickham, S., (2001).  "Vitamin K - an alternative perspective." Aims Journal. 2001.13 (2)

http://www.parentscentre.org.nz/

http://www.adhb.govt.nz/newborn/Guidelines/Blood/VitaminK.htm

When should you call your midwife?

Pregnant or new mums are often unsure when to call their midwife, here is a guideline but should you have any concerns about you, your pregnancy or your baby, the midwife will want to hear from you.  Your health and your baby's health is very important to us, so please call us.

In pregnancy

• If you have any vaginal bleeding.
• If you think your waters have broken.
• If you are worried about your baby's movements (eg., less than 10 movements in 12 hrs).
• If you have regular painful tightenings/contractions before your due date.
• If you have headaches, see 'flashing lights' in front of your eyes, or indigestion type pains that wont go away.
• If you have any pains in your back or abdomen.
• If you think you have a bladder or kidney infection.
• If you have been in contact with an infectious disease like chicken pox, slap cheek or TB.
• If you have any worries about your pregnancy.

 In labour

• If you have regular contractions.
• If you think your waters have broken, even if you have no contractions.
• If you have any bleeding.

After you have your baby

• If your bleeding suddenly becomes heavy again.
• If your discharge becomes offensive smelling.
• If you think you have a temperature or feel unwell.
• If you think your baby is unwell.
• If your baby is not feeding.

The link below is a link that will take you to a pregnancy website
http://www.ohbaby.co.nz/pregnancy

Breast feeding

Breast is best!  You will hear us and other health professionals continually reinforce that breast is best.  

Can anyone breast feed?  The answer is yes.  
Does everyone have the same shaped breasts and nipples?  No, having different size breasts and nippes does not mean you cannot breastfeed your baby.
My nipples are flat!  The baby actually suckles on your breast and not the nipple.

There are awesome benefits for both you and your baby if you breast feed (Riordan & Wambach, 2009), here are some listed:


Mum

• Promotes bonding between you and your baby.
• Helps your uterus return to its pre-pregnant state quicker by releasing oxytocin also called the love hormone. (Michel Odent, Sarah Buckley) when your baby suckles.
• Builds up bone density to reduce the risk of osteoporosis in later life.
• Reduces the risk of ovarian and breast cancer.
• Possible quicker return to pre-pregnancy weight.

Baby

• Reduces the risk of asthma and respiratory infections.
• Reduces gastrointestinal infections.
• Protects against SUD's (Sudden Unexpected Death Syndrome).
• Helps protect against allergies.
• Possible higher IQ scores. 
• Less ear infections.

When your baby is born he/she will be birthed onto your abdomen for skin to skin contact.  This wonderful contact assists with temperature control (you and baby), helps with bonding, helps your baby to adapt to his/her new world and promote breastfeeding.

For the first three days following the birth of your baby, you will produced colostrum (in fact you may leak some colostrum in the last trimester of pregnancy, this is normal but do not try to express any from your breasts, it may lead to  premature labour).  Colostrum is rich in protein and helps coat the lining of your baby's gut to protect against bacteria, illnesses and viruses.  



The mature milk usually comes in on day three following birth, although sometimes it can be delayed if you have had a caesarean section.  Because of the composition of breastmilk, your baby does not need any extra water, fluids or solids for 6 months, that is because your milk is uniquely produced for your baby and in the exact proportions your baby needs.

Know that you will produce enough breast milk if, you allow your baby 'free access' to the breast.  In other words, let him feed when he wants for as long as he wants.  The suckling on your breast stimulates the release of hormones to build up your milk supply.  You have no rules and regulations about when you eat, so dont expect baby to follow any.  Enjoy your baby and breastfeeding - it really is a wonderful time for both you and baby.

Speak to your midwife about benefits of breastfeeding, it really is best for you and baby.  I have put some weblinks to breast feeding organisations.

Riordan, J., & Wambach, K.  (2009).  Breastfeeding and human lactation (4th Ed).  Jones and Bartlett:Boston

'The Love hormone'   

http://midwifeinfo.com/articles/michel-odent-primal-health-and-the-scientification-of-love 

 http://www.sarahbuckley.com/

Breastfeeding and where to get help

http://www.lalecheleague.org.nz/

http://www.midwife.org.nz/index.cfm/1,78,0,0,html/For-Women
http://www.moh.govt.nz/moh.nsf/indexmh/breastfeeding-help#midwives