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

Home Birth or Hospital Birth?

Are you going to have your baby at home or hospital?  How many times have you heard that hospital births are safer than home births?  I have heard this said many times during my midwifery journey when discussing birth place choices with women.

Would it surprise you to learn that, for low risk women (eg., women who have no medical concerns regarding themselves or their unborn babe)  home births are as safe if not safer than hospital births (Johnson & Daviss, 2005).  It is safer because at home there is less medical intervention, less pain relief and less instrumental births).  The woman at home is more relaxed and in more control to make decisions (Kontoyannis & Katsetos, 2008), she also feels safer in her own surroundings.  It is known that if animals in the wild are disturbed or feel unsafe or stressed, they will stop their labours until they have found somewhere quiet and dark.  The hospital environment is a strange and unfamiliar one and it can a scary place if you have never been in hospital before, and  If women are very anxious and stressed their labour can slow down, possibly leading to a cascade of interventions.  I am not saying that all women who have their baby in hospital are going to have medical intervention because not all will, however, the risks are greater.

We could debate the patriarchal intervention that came about when data from a British study had been misinterpreted and, the study claimed that home is a dangerous place to birth (Tew, 1995), but we will save that story for another time. Midwives in New Zealand and worldwide are trained to detect any deviations from the normal, that means, if she feels that a problem is arising during your pregnancy/labour or birth, she will, with your consent, discuss the concern with the obstetrician or paediatrician.  This may mean transferring you to hospital but it should be a three way discussion between you, your midwife and the obstetrician. 

The main point is that you have a choice to birth at home or hospital so please discuss your options with your midwife. For women and midwives who would like further reading, I have put the references in full below, also, for those interested in having a home birth a link to the home birth association and the New Zealand College of Midwives are included.

http://www.homebirth.org.nz/ 

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

Johnson K.C., & Daviss, A. (2005) Outcomes of planned home births with certified professional midwives:large prospective study in North America.  British Medical Journal, 330, 1416.

Kontoyannis, M., & Katsetos, C. (2008).  What influences women in Athens to chose home births?  British Journal of Midwifery,16(1),44-49.

Tew., M. (1995). Safer childbirth?  A critical history of maternity care (2^nd ed).  London:Chapman and Hall.

Antenatal blood tests

When you see your midwife for the first time she will take a detailed history of your health, your previous pregnancies and your present pregnancy.

This is a very brief introduction to the blood tests so please talk with your midwife, she can offer a more detailed explanation.


A full blood count will be done to check your haemoglobin (iron) levels to make sure that you are not anaemic.  If you iron levels are low, your midwife will discuss your dietary intake of iron and you may need to take iron tablets. 


Your blood group (O, A, B AB) and rhesus factor (negative or positive) will be tested.  If you are rhesus negative you will have further blood tested at 28 weeks and again at 36 weeks to ensure that you are not developing antibodies that affect your baby (usually in second and subsequent pregnancies) by seeing it as a 'foreign body.'  You may require an injection of Anti D immunoglobulin during the pregnancy and/or after the birth of your baby.  At birth blood will be taken from the umbilical cord and then your baby's blood group will be tested.  If your baby is rhesus negative, you will not require Anti D, if your baby's rhesus factor is positive, you will require Anti D.  Simply put, the way Anti D works is by coating any fetal  blood cells that have escaped into your blood circulation following the birth to prevent any antibodies forming that will affect a subsequent pregnancy.


Rubella or Germany measles is checked to see if you immune.  If you are not immune, you cannot be vaccinated during pregnancy, your GP can vaccinate you after you have delivered your baby.  


Your blood is also tested for syphilis and Hepatitis B. If you are a carrier of Hepatitis B, your baby will be vaccinated at birth.  You will also be offered an HIV test, this is because early detection can reduce the risk of mother to child transmission.

You will also be offered maternal serum screening.  We will not discuss that test here, please talk to your midwife.


All women have their blood rechecked at 28-32 weeks of pregnancy for Iron levels, antibodies and a polycose will be done.  A polycose is to check that you are not developing gestational diabetes (diabetes in pregnancy).

Birthing in New Zealand

How I love the philosophy of partnership and birthing here in New Zealand.  I came to this beautiful country about nine years ago and fell in love with its peoples and the country.  Here, was the midwifery I have always wanted to practice.

I trained in England and the word 'autonomous midwifery' was banded around but I am not certain that anyone knew what the true meaning of the word meant.  It was not until I came to New Zealand and it left me hungering to know more of the partnership in care model.  For the first time I knew what 'autonomy' was and it was like one of those 'eureka' moments - YES, this is autonomy.

The pregnant woman and her family are equals in the partnership of care with her midwife, giving them a voice here where they are often not heard in other places.  Unfortunately in most countries the system is male dominated and this, effectively wipes away centuries of human history where Midwifery was the domain of the woman.  These women were the 'wise woman' in their villages and used the knowledge of herbs and the natural world to help and heal their fellow humans.  

Here is a link to the New Zealand College of Midwives for both midwives and women
http://www.midwife.org.nz/index.cfm/1,78,0,0,html/For-Women

And for parents
http://www.parentscentre.org.nz/ 


      

Waterbirth

Waterbirth is the art of labouring and giving birth to your baby in water.  The bouyency and warmth of the water is said to help women move around more easily, help with pain relief, and the progress of her labour may be faster.  The evidence suggests that the warm water environment (preferably with low lights and quiet) allow the mother to be in complete control where she can rely on her own instincts, and release her own body's endorphins.


Endorphins are a natural morphinelike substances produced by the body in reaction to stress and pain.  It is a very powerful form of pain relief that alters the woman's conciousness and helps her to cope with her labour.  It is this same substance that causes her to become suddenly 'alert,' awake and fully aware when her baby is born.  For anyone who is lucky enough to have witnessed this phenomena  can see that the labouring woman will go into "her own space" or level of consciousness as she connects with her baby and copes with the pain of labour.  She may not be aware of time or even people in the room - she does not mean any offence to the ones she loves :-) it is her body's wonderful endorphins helping her through this intense experience.

The benefits of water: Actually that goes for anyone who has pain in their body, we all the know the effect water has on us for pain :-)

• It supports your uterus and your back.  It reduces anxiety and helps relax you.
• It is said to reduce the risk of perineal tears
• Reduce the need for pain relief
• The baby adapts gently to life outside the womb
• Better for baby if mum has less pharmacological pain relief

For the women considering a waterbirth as one of their options, there is a certain criteria.

• Low risk. In other words, there have been no concerns regarding you or baby during the pregnancy, you must be more than 36 weeks pregnant and your baby is positioned in the womb with his/her head down in the pelvis (not breech).  Although some midwives do carry out breech waterbirths.
• You are in established labour.  Established labour is where your neck of the womb or cervix is at  least 4cms dilated. Getting in the water too early in labour, may slow it down, hence why we do not like you getting in too early.
• If your waters have broken, the fluid must be clear.  Any colour other than clear, means your baby has opened his/her bowels in your womb, this means we need to monitor your baby more closely.
• You have not already had pain relief that makes you sleepy eg. pethidine.

 It is one of the wonderful ways to give birth and an option you may choose.  Speak to your midwife about waterbirths.  Some links here may help :-)

http://www.homebirth.org.nz/stories/stories.html
http://www.waterbirthinfo.com/menu.html

Plaster off - Yippee

WOW!  Is it really all this time since my last blog?  Well, I have my plaster off now, thank goodness.  Funny thing, I thought it would be 100% better as soon as the plaster came off, but no, I didnt expect the aches and pains I thought I would get.  I shouldnt winge because it could have been worse - but HEY, it is my dominant hand, so maybe I cant winge a smidge :-)  Anyway it will recover in time - so I just have to be patient. 

Well our time in the US was just AWESOME!  Wonderful catching up with great friends and family, ah just bliss.  Cept for trippin' ass over tit (excuse my French) - and breaking my arm.  Oh well.  I was seriously thinking this week whether I should do a lactation consultant course OR continue with my masters.  Hmm, will mull that one over.