Thursday, 28 October 2010

Watching your own birthing experience and Alfred Hitchcock type appearances

The legendary feature film director Alfred Hitchcock often made fleeting cameo appearances in his own films; film buffs and critics would watch avidly and study his films carefully to find his Hitchcock moment. When I went to film Amy’s birth I hadn’t envisaged a Hitchcock moment, but fate took a hand and I was given, not a fleeting moment but a starring role.
Amy had not realised that her labour was so advanced and had delayed calling Virginia her midwife who set off to Amy’s house with green lights flashing, like a scene from a Hollywood action movie. I had arrived first and realised the birth was imminent- I spoke to Virginia on her hands free phone and she said she was only minutes away. I suddenly realised that the baby’s head was almost out, luckily as well as being a film maker I was a midwife with over ten years experience. With just a couple of pushes baby Honey Safia made her entrance into the world caught by me, the film director, just as Virginia rushed into the room.
Virginia was relieved that the birth had been straightforward and after a few checks on mother and baby was satisfied that all was well.

Last week I took Amy’s birth diary to show her. I always find it a bit daunting when showing women their Birth Diary. Will they like the edited version of their story? Will it be a moving experience for them, and will it give them a different perspective on the labour and birth? Amy was thrilled and I was relieved. It is now up on the site and ready to view and my Hitchcock moment is on the site for all to see.

Friday, 22 October 2010

Too much alcohol and pregnancy don't mix

I have just read in my paper that a neonatologist from our local hospital is applying for a government grant to research the impact of drinking during pregnancy on unborn babies. Those involved in infant and child health are reporting an increased incidence of Fetal Alcohol Syndrome (FAS). Government statistics state that over 24% of the population now drink well in excess of the recommended units of alcohol per week. When I qualified as a midwife in the early 1980’s I had never heard of Fetal Alcohol Syndrome; it was something only a paediatrician would come across, and rarely, but today I suspect every paediatrician in the country can cite cases of it.
Fetal Alcohol Syndrome is the most common cause of abnormalities in babies and children, it produces a multitude of symptoms and signs from facial abnormalities, organ defects, growth retardation, mental and intellectual disability and behavioural problems to name but a few-It is 100% preventable.
Coming from both a television media and midwifery background I can see both cause and effect; I remember from the late 1990’s onwards, broadcasters revelled in programmes which explored the salacious lives of holiday reps and holiday makers, highlighting the antics of those who had drunk too much and seeing this as entertaining television. These types of programmes continue to be made because they are cheap. The problem with this type of programming is that it gives young and impressionable people the idea that they can only have a good time if they get drunk and disorderly, that this is the norm and it is expected of them on a Friday and Saturday night. If they can’t remember what happened the next day, even better. For women and their partners planning a pregnancy this activity is hard to stop and they continue into their pregnancies.
The cost of all this drunken activity is to be seen in our A&E, maternity, neonatal and paediatric wards, with adults suffering from the effects of too much alcohol, infants showing signs of withdrawal from alcohol, and young children developing signs of Fetal Alcohol Syndrome.
The answer is that anyone planning to make a baby should cut right down on their alcohol intake- and that includes their partners too, as alcohol affects sperm quality. Once you know you are pregnant the best advice is to cut out alcohol completely- different paediatricians and neonatologists have different views on this, so the safest option is complete abstinence, fortunately for many women they find they go off alcohol anyway. The most important period for abstinence is in the first three months when the fetus is developing rapidly.
So, in the light of the recent government spending review, I do hope that this neonatologist gets his funding, as we are in the middle of an epidemic of alcohol related problems

Monday, 11 October 2010

Causes of rising caearean rates?

I read an article on the BBC news site about ‘too posh to push’ being a total myth, and women overall are not demanding elective caesarean sections, but being advised to have a caesarean section when a pregnancy or labour deviates from normal, and yet the caesarean section rate is rising year on year. So, the question is, who decides what is normal and what is not? I think that there is a strong element of ‘if in doubt cut it out’ but women are not being given all the information to make a truly informed choice, and obstetricians are only too aware of litigation should a labour and birth not proceed as planned.
There is also the possibility of health professionals affecting how information is given to women during pregnancy and how that information is received- I remember a few years ago reading an article which discussed Queen Charlotte’s Professor Nicholas Fisk’s anonymous survey of 282 male and female obstetricians working in the NHS across London. Some 31 percent of female obstetricians and 8 percent of male obstetricians would request a caesarean section for themselves or their partners in the absence of any medical need. I think this is really sad as it shows that these professionals don’t have confidence in their own bodies to deal with a natural process. Some of their reasons for requesting caesarean section are cited as wishing to prevent perineal injury and stress incontinence, but they don’t consider the injury incurred by a caesarean section cutting through abdominal wall, muscle and uterus as potentially dangerous too. I have met women who still have stress incontinence even though their babies were born by caesarean section, so that argument doesn’t cut the mustard with me.
There is also the alarming increase in diabetes and obesity sweeping this country- I remember talking to a midwife who ran a clinic for diabetics- ten years ago she would see one or two clients a week, now she has whole clinics of twenty or more a couple of times a week. The ultimate result in this astronomical rise contributes heavily to the rising caesarean section rate.
Then, there is the spectre of thousands of job cuts within the NHS which were predicted earlier this year. The government promises that front line services will not be cut or affected, but, for example if you take away clerical support staff out of a ward, then the only people left to do the paperwork are nurses and midwives, and they are already drowning in a sea of paper and technology.
And then, only a few days ago several hospital trusts announced that maternity units were going to close- where will the women go who would have had their babies in these units? The answer is that they will have to go to larger hospitals where the staff are already hard pushed to provide a safe and adequate level of care.
There are many situations where, during labour or in the last weeks of pregnancy signs appear that all is not well, and the woman and her unborn baby will need extra monitoring. I suspect that in the light of further cuts to our NHS services, many of these women will be offered a caesarean section rather than the maternity unit facing an investigation into inadequate care after the event. Sadly I believe that our current overall statistic of 24% caesarean section rate will continue to rise, and the unusual birth experience will be that of normality.

So, what is the solution to the problem? I believe there is a multi faceted answer- firstly women must take responsibility for themselves, they must become healthier and eat a balanced diet, cut out alcohol and stop smoking all long before they decide to get pregnant, they should ensure that they are well informed about their pregnancy and birth by attending ante natal classes, and finding out as much information as they can through different media including the internet, joining discussion forums will help in broadening their views, and will lead to them being better prepared for labour and parenthood.
Our government must stick to its promises and save our NHS from any further cuts- yes there are ways of becoming more efficient but women will still need a good midwife to have a great birth experience. vaginal birth after caesarean gestational diabetes video