Maternity Experience

Postnatal Care

#MatExp Whose Shoes? update

Some really exciting developments with #MatExp Whose Shoes? at the moment.

Bromley MSLC produced a ‘one year on’ report following up on their Whose Shoes? workshop at King’s College hospital using “I said, I did” as a framework to list all the fantastic outcomes that had come from pledges made on the day.

Language continues to be a big issue for women and families, but some great initiatives are now happening. Building on the Whose Shoes? workshops, Leeds and Colchester in particular are working on specific language challenges. I came up with a ‘Negativity Bingo’ and had great fun with my team at the NHS Fab Change Day #DoAthOn event launching #DumptheDaftWords.

I have been getting some exciting invitations to speak about building social movements and of course gave #MatExp a big shout out in my talk at the launch of #AHPsIntoAction, they have invited me back for a longer keynote session at their annual conference in June.

More hospitals are coming on board with the Whose Shoes? approach – the energy is particularly strong in London, the West Midlands and the South West regions. It has been great to present on several occasions now with Catherine MacLennan and Emma Jane Sasaru and to see people learning so much from their courageous sharing of their lived experience.

Last Friday, 3 Feb 2017, we were invited to present a #MatExp Whose Shoes? session to get some good discussions going as part of a packed event launching #PanStaffsMTP in Stafford. We concentrated specifically on continuity and perinatal mental health. This is the county-wide transformation programme to improve maternity experience in Staffordshire to implement the national ‘Better Births’ vision. This informal film gives you a flavour.

We are proud of the crowdsourced ‘Nobody’s Patient’ project and thank everyone for your fantastic contributions. We now have over 120 new Whose Shoes? scenarios and poems and the new resources will be made available shortly to all the hospitals who were existing customers. Florence Wilcock, Sam Frewin and I are finalising the supporting toolkit and collating the case studies, ahead of our ‘wrap up’ event in March. We are trying to pull together lots of ideas for positive change, with or without a workshop. I hope you are enjoying the regular Steller stories, including Florence’s monthly reports.

Wonderful to see everyone doing such amazing work, speaking all over the place, building networks, spreading the word and generally making great things happen.

Keep up the good work!

Gill Phillips @Whose Shoes

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Bedsharing, Breastfeeding and Family Centred Care

It started with a thread about infant feeding that the lovely Lucy began on the #MatExp Facebook group.  It was a fantastic discussion with a realistic and compassionate look at all kinds of barriers and problems, but one comment from student midwife Amy Prodgers stood out for me the most:

“Have found this discussion really fascinating as have been reflecting on similar issues after my first week on postnatal ward as a student midwife. I could go on about loads of things but a key point for me is the conflict between safe sleeping advice and facilitating breastfeeding. Women are exhausted from their birth experiences and their babies just want to feed but can’t sleep together. Women then end up feeling a failure for not being able to settle their babies in the cot, whilst also feeling guilty for wanting to sleep. This is when women start asking for formula and when midwives begin to doubt their intentions. Totally undermines confidence.”

I started a new thread with this comment at the top, and tagged in Gill Phillips as I felt it would make an excellent scenario for the WhoseShoes game that is used in #MatExp workshops around the country.  We then had a discussion about bedsharing that raised some important points, and I felt it important to capture that discussion and share with you here.

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Via https://www.facebook.com/BellyBellyBaby

What was quickly brought up was the co-sleeper cots that used to be available to women on some postnatal wards.  This article was linked to: http://www.scarymommy.com/hospitals-everywhere-should-have-this-amazing-co-sleeping-bed-for-new-moms/ and I remembered that midwife Jenny Clarke had been tweeting about them this year.

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An IBCLC on the group explained that “The old co-sleeper cots don’t fit the new beds (which were needed to reduce back strain on staff). However there are several new designs that fit the new bed, and research starting up too. Helen Ball’s research and videos of mothers clearly showed that the co sleeper cots made things *much* easier for mothers, much happier for babies, and didn’t add to staff’s workload.”

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But would co-sleeper cots solve the problem?  A paediatric consultant commented “I had co-sleeper cots after both my deliveries but actually my babies just wanted skin-to-skin for the whole first night. I think we really need better hospital beds in maternity and children’s wards to facilitate bedsharing.”

The important thing to bear in mind here is that these babies are displaying completely normal behaviours.  It is our maternity wards that need to be “fixed”, not the babies.  For a lot more discussion about expectations and reality when it comes to infant sleep, please see this blog by Alice Amber-Keegan of the Infant Sleep Information Source: https://growingfamilies.co.uk/2016/09/04/infant-sleep-expectations-and-reality/

Founder of the Positive Birth Movement, Milli Hill, agreed that “co-sleeper cots imply that at some point your baby will not mind being put down separately from you, and that you won’t mind putting them down separately either! Not always what mum or baby wants or needs.”

And of course, not having baby on the same surface as you can make life very difficult for post-birth mothers, as Polly Rogerson pointed out: “I was in hospital for a week after birth [due to post-partum haemorrhage], I was so weak that I couldn’t even lift my baby out of the cot – even with it right next to the bed. Yet somehow I was expected to do exactly that to try to feed him.”

Bedsharing when Baby is Unwell

The conversation then went in a couple of different directions – one discussion of bedsharing on children’s wards when a baby is ill, and one discussion of the guidelines that trust’s expect health visitors to follow when discussing bedsharing with the families they support.

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Anyone who follows my hospital breastfeeding campaign will know how excited I was to have a paediatric consultant say that it would be good to have bedsharing facilitated on children’s wards!  The consultant in question went on to say:

“Because in real life, I’d say close to 100% of families bedshare when children are ill. Banning it on hospital wards is just stupid. Having informed discussion about it is sensible.”

She clarified that her reservation for bedsharing with unwell children “is smoking parents and small babies and children with respiratory illness, as it is unrealistic to expect parents to stop smoking at such a stressful time, but the smoke clinging to clothes and hair definitely seems to exacerbate the children’s respiratory problems.”  However this doctor confirmed:

“I spend a lot of time at work putting babies and children back into parents’ arms. That’s where they are usually happiest, but most importantly for me, most physiologically stable!”

This issue came up on my own private Facebook group today, as a member explained that her niece was hospitalised (and will likely be so for some time) and is refusing to sleep anywhere but on mum.  As mum is unable to bedshare in hospital due to lack of facilities, mum is getting very little sleep.

A paediatric nurse on my group explained that from her professional perspective “we never advocate or advise co sleeping in our hospital as the babies are with us due to illness & therefore it can increase the chances of problems. However it is a parent’s choice and some still do, but we are bound by our duty of care to highlight the implications.”

She went on to say though:

“I’m a big believer in family centred care (which all children’s wards/nurses/professionals should be) so if a parent still wants to co sleep (and they would do so at home) I feel it’s my duty to help that parent as best I can so their wishes are upheld, but in a way that I feel most comfortable with in my work setting. As a children’s nurse you’re not only nursing the child but the whole family too, so to keep things as they would do at home or in regular life is important; the change of circumstance by being in hospital is bad enough for the child and family never mind then saying ‘well sorry you can’t keep your normal routine whilst here’. I think sometimes as a health professional we’re so focused on making that child better medically it can be forgotten how big a change being in hospital can be on them emotionally; even though they may not outwardly show signs of distress it is definitely affecting them psychologically, and therefore keeping things as much to their norm as possible is very important.”

 

Bedsharing when Baby is at Home

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Image courtsey of Beverley Latter and the Infant Sleep Information Source

The discussion about what health visitors can and can’t say to new parents was prompted by one mother explaining “my health visitor at 6 weeks (1st baby) gave me info about safe co-sleeping and it was the reason I continued to breastfeed.”

I then shared the discussions that mothers from my group have had with health visitors online, including a discussion specifically about bedsharing: HVe-COP newsletter  The two quotes from that discussion that summarise the issues for me are:

“We are very constrained sometimes. We have to follow Trust policy…..even if we believe that bed sharing can be very beneficial and are up to date (with evidence)” (health visitor participator)

“Just to put this out there…….we have a responsibility to our NMC Code of Practice and the clients…after that Trust policy is important. The day health visitors do not provide evidence based information to their clients because of Trust policy is a grave one indeed” (health visitor participator)

On this thread in the #MatExp group, one health visitor explained: “Trust guidance is the Lullaby Trust safe sleep recommendations, and signposting to NICE for bed sharing…..personally I don’t advocate it but I talk about if [you are] bedsharing [how to] minimise risks.”

This conversation took place before the launch of the new Baby Friendly “Co-sleeping and SIDS” guidance for healthcare professionals, which has been developed in conjunction with the Infant Sleep Information Source and the Lullaby Trust.  This guidance focuses on helping healthcare professionals “to take a sensible, proportionate parent-centred approach in order to find practical solutions to this complex issue”.

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We can hope that this guidance and the continued expansion of Baby Friendly training for UK health visitors will put an end to less nuanced campaigns such as this one from Bolton, Wigan and Salford that Amy Prodgers highlighted:

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As you can imagine, this heavy handed campaign elicited a strong response from those on the thread!  Amy herself commented that “reducing SIDS by telling people not to bed share is a bit like reducing road traffic accidents by telling people not to use cars! And of course we’ll also avoid the issue of how much more dangerous it is to fall asleep on the sofa (whilst presumably trying your best to follow this advice and stay awake).”

One mother’s experience explains the reality of what happens when health visitors advise against bedsharing: “When I told my HV I was co-sleeping, on purpose and in accordance with safety instructions, she gave me leaflets on ‘cot death’ and strongly discouraged me from doing it. She then arranged another visit for a few weeks later, after advising me to ‘keep trying with the moses basket’. When she returned I just lied and said that my baby was now sleeping in the basket as I couldn’t be arsed with having to defend my conscientious parenting decisions.”

 

For information on the practicalities of sharing a bed with your baby, please see this detailed post by Elena Abellhttps://growingfamilies.co.uk/2016/06/15/the-practicalities-of-sharing-a-bed-with-your-baby/

Or see the “Safe Sleep Seven” from La Leche League:

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And for the latest research on bedsharing, infant sleep and SIDS please see the Baby Friendly website: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/infant-health-research-bed-sharing-infant-sleep-and-sids/

 

Midwife Sally Goodwin said at the end of the thread that she was “grateful to all for highlighting this issue. I think this subject comes up erm…… every day for me as a midwife.”

Certainly a topic we need to continue to discuss then.

 

Helen Calvert
November 2016

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Excessive Crying – What’s The Right Response?

Our thanks to Sally Hogg for this blog post.  Sally is a mother who works in children’s policy, research and practice, and has done extensive work on the subject of excessive crying in infants.

Sal
Sally Hogg, @salhogg

All babies cry and some babies cry a lot; between 10 and 20 per cent of babies will cry excessively during the first three months of life. As professionals, we know that this crying is normal and will pass. But for parents it is tough. Really tough.

“There were times when I resented him for screaming, and then hated myself for feeling like that, and also for not being able to make it better. I just felt a huge sense of failure.”

While most families survive a period of excessive crying relatively unscathed, it does increase the risk of a range of poor outcomes including maternal mental illness, relationship breakdown, child abuse and childhood behavioural problems.

Parents of babies who cry a lot will often try to identify a cause of this crying, and, with it, a solution. This isn’t helped by the fact that excessive crying is generally known as ‘colic’, leading to the common misconception that it is caused by stomach problems. In fact, excessive crying has been shown to be associated with digestive problems in only a small subgroup (around 5-10 per cent) of babies who cry excessively. For other babies, the causes of excessive crying might include temperament, early sensitivity, feeding problems, or a poor fit between parenting expectations and behaviours and babies’ needs. For many babies, we will never really know why they cry a lot.

Crying is one of the most common reasons that parents seek support in the postnatal period. In these situations, it can be tempting to suggest a ‘cure’ for the crying, or to reassure the parent that crying is normal. Both the academic evidence, and the experience of parents, tell us that neither response is appropriate.

It is not appropriate to simply suggest a cure for the crying – whether that be winding, infancol, changes to feeding, or actions like walking the baby in a pram or carrying him. These actions might work for some babies, but not for all. There is no ‘one size fits all’ solution to crying – all babies are different and can cry for a huge number of different reasons, requiring different responses.

It is also not appropriate simply to reassure parents that crying will pass. Even if the crying is normal and the baby fine, excessive crying is hugely difficult for parents and can damage their self-esteem, self-efficacy, mental health and wider wellbeing. So some form of response is required.

So what might an appropriate response to excessive crying be?

Based on a review of the evidence, and in particular a useful article by Ian St James Roberts I would suggest that a good response to excessive crying has six parts. These are set out below. I’ve also highlighted where we might take action in the antenatal period to prepare parents to cope with a crying baby.

  1. Building awareness of babies’ development.

The first three months of a child’s life (sometimes called the ‘fourth trimester) is a distinct phase of babies’ development, in which they are not yet able to regulate themselves, and in which their crying has particular characteristics. Ronald Barr refers to the ‘period of purple crying’, where the acronym ‘purple’ describes different features of babies’ early crying.

Supporting all parents – both antenatally and postnatally – to understand this developmental stage, and to know that it will pass, can be really helpful. (Although there isn’t a magic transition point at three months and each stage of children’s development brings new and different challenges, so it’s important to manage parent’s expectations!)

  1. Help parents to understand the stress that they feel and how to cope with this.

It is normal for parents to find their baby’s crying stressful, but hard to admit this. We can help parents by normalising this experience, making it acceptable to talk about how one feels when a baby cries, and helping parents to think about ways to deal with this. Evidence shows that giving parents coping strategies to deal with the stress they feel when their baby cries, together with educating them about the importance of not shaking baby, can help parents and reduce the risk of abuse to babies. The NSPCC’s Coping with Crying Programme has shown the value of sharing these messages with parents in the antenatal and postnatal period.

  1. Provide a menu of options

There are many reasons why a baby might cry and many ways to help babies to keep calm, or to soothe them when they cry. These could be shared with parents antenatally, to help provide them with a ‘toolkit’ to draw from when their baby cries.

When a baby is crying excessively, it is useful to help parents to consider their own baby’s experiences and needs, and to identify what actions might help them. Evidence from successful interventions suggests that the most effective responses to excessive crying involve reassuring and supporting parents, and helping them to formulate hypotheses about why the baby is crying and identify and test actions to reduce their babies’ crying or to make it feel more manageable. One intervention, Possums, uses five domains – infant health, mother health, feeding, sensations and sleep – to consider the families’ needs and identify actions.

  1. Help parents to enjoy their baby.

When a baby cries excessively, this understandably becomes the focus of parents’ attention. But the perinatal period is a formative time when parents develop beliefs about their child’s personality which can influence how they interpret and respond to the child’s behaviour and the quality of their interactions. It is therefore important to highlight a babies’ wider characteristics, and help parents to enjoy the positive interactions that they have with their baby so that they don’t develop too negative an image of their child based on their crying.

  1. Frame crying as an experience and not a symptom.

It is helpful to address the idea that crying is a sign that there is something ‘wrong’ with the baby, either physiologically or emotionally. Helping parents to see excessive crying as a part of their baby’s experience of early life, rather than a symptom of a medical problem or a sign of poor behaviour, can help them to focus on how best to soothe their baby and cope with crying during this stage.

  1. Be Kind.

Finally, let’s not forget that excessive crying is really hard, and parents can feel feelings of isolation, helplessness and failure. These mums and dads need a kind, compassionate response and ongoing support.

“More helpful still were the very few people at health clinics who bothered to learn my or my babies’ name, who offered to hold him for a little bit, and who were interested in how I was doing. These people were few and far between.”

Sally Hogg

2016

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Women’s Voices in #MatExp – your GP

I was asked to do a talk to student midwives at Salford University in January on the topic of “Women’s Voices” in maternity care.  As part of my presentation I included the voices of the midwives who work in maternity care, and a reminder that there are many other women for whom maternity care is their professional, as well as perhaps their personal, experience.  “Women’s Voices” in maternity care should cover the midwives, obstetricians, health visitors, doulas who care for us, as well as the women giving birth.

So I decided to start a series of blog posts on “Women’s Voices in #MatExp” from the point of view of those working in maternity, and this is the eighth of those. This is Louise Santhanam’s experience as a GP – thank you so much to Louise for agreeing to write for us.  You can read the other blogs in the series here:

Your Midwife

Your Doula

Your Breastfeeding Supporter

Your Sonographer

Your Obstetrician

Your Anaesthetist

Your Antenatal Teacher

And yes, I will be doing a “Men’s Voices in #MatExp” series too.  Because this campaign is about all voices.

Helen.x

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Louise GP

It is a privilege to be included in this series of blogs and to talk about being a GP in the context of Maternity Care. My name is Louise Santhanam and I am a General Practitioner and mum to 3 children under 7 years old. Unlike some of the other voices in this series, I am currently taking a short career break (more on that later). I have recently become involved with the #MatExp community, and it is extremely uplifting as a clinician who cares about the whole person and the family to see so much positive work going on, at a time when the NHS is facing uncertainty and extreme challenge.

Probably the biggest difference between the role of the GP and the other professionals who have already told their story here is that Maternity care is one strand of what we do. A GP will often look after a Mother or a couple prior to conception, then on through their pregnancy into the postnatal period, and beyond. The GP will be responsible for the care of baby, siblings and often Dad too, so we have a unique perspective and a responsibility to promote and protect the health of the whole family unit.

Rather than meaning we just ‘didn’t specialise in anything’, being a General Practitioner means that we have to know a fair amount about lots of things- both medical and social. After congratulating a mother on her new pregnancy, we might be supporting someone with serious mental health problems, diagnosing a possible heart attack or helping adjust a patient’s blood pressure medications- and each case is expected to be managed in around 10 minutes!

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We have to be quick to use our common sense and apply our training to help when unusual circumstances arise. We might be dealing with common and chronic conditions one minute and then have to respond with urgency to an emergency the next minute. GPs have specialist training in the ‘art’ of the consultation: good listening, communication skills, negotiation and viewing a whole person rather than just an organ or a medical problem. It is our responsibility to be aware when we have reached the limits of our own expertise and when Specialist input is needed. We have to be good team-mates to our Practice colleagues and work with many people who we will never meet, over the phone, by email and by letter.

A GP might work ‘single handed’ (increasingly less common) or together with Partners to run their own Surgery either with a dedicated list of patients that they know well, or in a Group Practice where patients can see any of the doctors they choose. Alternatively, they can work as employees (Salaried doctors) or do sessional work (Locums doctors). Some GPs develop a special interest and increase their knowledge and skills in a particular area of medicine- for example Dermatology, Women’s Health, GP Training or Clinical Commissioning.

My personal journey to becoming a GP started with five years of medical school with an extra year of Physiology research, followed by four and a half years rotating through different speciality jobs in hospital, and then one year as a GP Registrar seeing patients in a GP Surgery. I am lucky to have been able to work in Paediatrics, Obstetrics and Gynaecology, Mental Health and Sexual Health, all of which have been invaluable to providing maternity care to patients later as a GP.

As a GP an average week might include the following and more- starting investigations for a woman who has been having difficulty conceiving, counselling a woman who has suffered a miscarriage, referring a newly pregnant woman to the Midwives for antenatal care, managing a woman with early pregnancy nausea and vomiting, urgently referring a woman with pregnancy bleeding at 32 weeks to the hospital Obstetric team, giving emotional support to a Mum of 3 who is fatigued in the days before her next labour, diagnosing a breastfeeding Mum suffering from mastitis, seeing a new baby for the 6-8 week check and reviewing a Mum’s caesarean scar during her postnatal check. And the next week it will be different again!

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All of these interactions with a woman and her baby through the maternity journey are extremely important and our responsibility as GPs is to treat a woman and her family with dignity at this significant time in their lives. Care of the Mother’s mental wellbeing and consideration of any other children and their needs is essential.  The skill of the GP is to identify what is important, what needs to be dealt with today, what needs to be followed up and what does not need to be worried about.

In the community we might signpost women to our Practice Nurse, the Midwives, our Health Visitor colleagues, their local Breastfeeding Support Group, a postnatal Physiotherapist or to not-for-profit organisations which can offer support with mental health problems, practical help at home and financial difficulties. When problems are identified, seeing the same GP can really make a difference to the outcome, as the doctor already knows the story, can quickly assess if things are getting better or worse and has already built a relationship with the Mother. Most GPs want to be able to support a woman to have confidence in her ability to birth and to become a Mother, continuing that support into the postnatal period …often to the next pregnancy and beyond.

As a GP work can be extremely stressful with long surgeries, large amounts of additional admin work and other non-clinical commitments like meetings and teaching juniors. Seeing patients at 10 minute intervals you can often feel like your brain is doing acrobatics moving from one scenario to the next. At the end of the day you can feel exhausted. GPs can feel the pressure of the responsibility they carry being the ‘gate-keepers’ to all the health service can offer, or as the sole person who has to decide whether the problem presented is serious or not. It can be heart-breaking to deal with women who have lost their pregnancy, to see the patient you have cared for over months struggle with postnatal depression or to see a new baby become seriously unwell. GPs are human beings too and many of us are also parents. Our branch of medicine takes gives us the privilege to walk along side our patients through the ups and downs in life and at times that can be overwhelming. My personal belief is that our Primary Care service in the UK is a ‘national treasure’ and is something that we should not take for granted. Everything a GP provides is covered by just £136 pounds per year per patient on their list (1). This does not excuse the occasions when care can and should be better, but just gives you an idea of the pressures on General Practice at the moment.

I have a personal interest in women’s and children’s health as I believe investment of time, money and effort in looking after a pregnant mother and a new family is the foundation for a healthy society. I am currently taking a career break, in order to look after my own family and restructure my working life. While I have been out of the Surgery I have been working for the Royal College of General Practitioners to raise the profile of Perinatal Mental Health issues and provide GPs with good educational resources to improve their care of mothers who are suffering mental health difficulties. It is really important that women and GPs appreciate that perinatal mental health problems are common. Between 10-20% of women will experience mental health difficulties during pregnancy or in the year after birth, and suicide is one of the major causes of maternal death (2). Once diagnosed perinatal mental health problems can be effectively treated so engaging in discussion about mood and feelings in the perinatal period can potentially be life-saving.

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I am also passionate about supporting mothers to breastfeed, something that is undervalued in the UK at present and reflected by low levels of prolonged breastfeeding in society. I see the provision of accurate advice to families on infant feeding and good Breastfeeding Support services as a duty for General Practice and the Community, not least because of the health benefits of Breastfeeding, but also because the early infant feeding journey can be emotional and challenging. With encouragement from members of #MatExp I recently set up an online Health Professional Facebook group called the GP Infant Feeding Network (UK). Through the positive power of social media myself and members are sharing good quality resources and educational materials on the issue of Infant Feeding and forging links with trained individuals in the field (Midwives, Health Visitors, International Board Certified Lactation Consultants (IBCLCs), Breastfeeding Peer Supporters and others). I personally believe it is so important that women are given reliable information about why breastfeeding is a healthy choice for themselves and baby and that if they want to choose to breastfeed, that they should be well supported to achieve their goals. Support from their GP can be very significant. I was amazed to rapidly make contact with many colleagues nation-wide who share my interest in this issue and have also made local connections, with the aim of increasing awareness of breastfeeding issues within my local GP community. Ultimately, GPs can have a role in all sorts of areas in maternity care and with public health initiatives, we don’t just work consulting at our desks!

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Despite all the recent negative media stories, financial difficulties for the health service and workload pressures in Primary Care, it is exciting to think that collaboration with colleagues can improve patient care and the experience of working in healthcare. Reassuringly, a recent survey demonstrated that patient satisfaction with their GP was 86% on average (3). When work in the GP Surgery was tough it was usually guaranteed that a consultation with an expectant Mum, or a 6-8 week baby check appointment could cheer me up and remind me that good things do happen in the world! One of the tasks that I always looked forward to was visiting a new baby at home following a homebirth. Entering the home on Day 1 of life to conduct the new-born examination in this situation is almost always an experience of tangible, joyful calm. Life is going on and the family is growing, and I was there to witness it happening. As GPs we need to be able to enjoy our work and look after ourselves so that we can continue to truly care for our community, from the maternity journey onwards.

Dr L Santhanam

General Practitioner

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If you are interested in joining the GP Infant Feeding Network (UK) please visit http://www.facebook.com/groups/gpifn/ or follow @GP_IFN on Twitter

Ref:

(1) http://www.hscic.gov.uk/article/6037/New-report-looks-at-the-NHS-payments-to-General-Practice

(2) http://www.rcgp.org.uk/clinical-and-research/clinical-resources/~/media/Files/CIRC/Perinatal-Mental-Health/RCGP-Ten-Top-Tips-Nice-Guidance-June-2015.ashx

(3) GP Patient Survey- National Summary Report July 2014, NHS England http://gp-survey-production.s3.amazonaws.com/archive/2014/July/1301375001_Y8W2%20National%20Summary%20Report_FINAL%20v1.pdf

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Women’s Voices in #MatExp – your Breastfeeding Supporter

I was asked to do a talk to student midwives at Salford University last month on the topic of “Women’s Voices” in maternity care.  As part of my presentation I included the voices of the midwives who work in maternity care, and a reminder that there are many other women for whom maternity care is their professional, as well as perhaps their personal, experience.  “Women’s Voices” in maternity care should cover the midwives, obstetricians, health visitors, doulas who care for us, as well as the women giving birth.

So I decided to start a series of blog posts on “Women’s Voices in #MatExp” from the point of view of those working in maternity, and this is the third of those.  This is El Molloy’s experience of supporting breastfeeding.  Thank you so much to El for agreeing to write for us.

You can read the first two blogs in the series here and here.  And yes, I will be doing a “Men’s Voices in #MatExp” series too.  Because this campaign is about all voices.

Helen.x

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I am an NCT Breastfeeding Counsellor in Coventry, and a Peer Supporter on the Infant Feeding Team (run by Coventry City Council).  I sit on our local MSLC (Coventry and Rugby CCG) and was a member of the Coventry Breastfeeding Strategy Group.  I am also a Babywearing Peer Supporter for Coventry Slings, and am about to do my Consultancy through Slingababy at some point this year. Probably after I finish the dissertation for my MSc in Child Health (through University of Warwick). I also help to facilitate the Coventry NCT Birth Choices (after caesarean or traumatic birth) Group after it was set up and run successfully by one of our amazing local Antenatal Teachers.

El Molloy

This is supposed to be a blog about Breastfeeding Support. Which means it also has to be about being a Peer Supporter – and being a Breastfeeding Counsellor. And now I don’t know who knows what those roles entail, or what we do in either of them. Is there a difference? Can parents tell the difference? Do they care? To be a Peer Supporter, or a Breastfeeding Counsellor – that is the question…I think?

I make a damned good cup of tea (and coffee – because I drink a *lot* of coffee). And at a push I can do cake, but usually I have biscuits. However this is all the icing on the cake or at least bribery, to encourage new mums to come to our groups, have a drink, have a biscuit, and stay a while. Let us listen to your story. And I carry tissues in my bag – always.

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As a peer supporter I have had UNICEF training in breastfeeding support (for most projects this is between 6 and 10, 2-hour sessions, delivered by someone who may be the local Infant Feeding Lead Health Visitor or Midwife/IBCLC/NCT Peer Support Trainer). I am a mother who has breastfed her own children. If you want to get technical I *am* a peer supporter – I am still breastfeeding my youngest. I can walk alongside you in your journey, I can tell you that things were and are occasionally tough for me – that despite the official badge and t-shirt (purple this time round, blue before – I declined the hot pink – it clashes with my hair!) I am not an “expert”. I don’t know all the answers – and I’ve yet to meet anyone who does. But as a peer supporter I can tell you what ‘normal’ breastfeeding should look like. I can tell you that there are no rights or wrongs, except what works for you and your baby. With the caveat that baby is happy and you are not in pain. And I can offer you information about what you need to look for in your babies feeding patterns so you can feel confident things are going well.

Does Peer Support make a difference? I’d like to think so – and I can see locally that overwhelmingly most families find us useful. There are always the other stories, the one about the PS who said to use baby rice at 4 months, but that’s no different to the story about the Midwife who said baby should sleep for 4 hours between feeds, or the Health Visitor who suggested controlled crying… One poor piece of information shouldn’t tarnish a whole section of support. This is something we are seeing every day on #MatExp. There is a world of difference between midwives and *this* midwife; between Peer Supporters and *this* Peer Supporter. And the supporters are only ever as good as their training and ongoing Continuing Professional Development (CPD) and supervision.

And this Peer Supporter is also a Breastfeeding Counsellor. Specifically, I am an NCT breastfeeding counsellor. This means, for the uninitiated, that I am trained in person-centred counselling skills, that I am a sign-poster to other information, other options, other Health Care Professionals. But that always the mother is front and centre. This too means that I have breastfed my own children (for a minimum of 6 months – though extenuating circumstances may apply for others). It means that rather than the UNICEF training, I have spent 3 years distance learning through a University accredited course, writing essays, going on weekend workshops. Debriefing my feeding experiences; embedding my counselling skills in practice as well as theory, understanding and training in group facilitation (for both antenatal sessions on courses, and in running breastfeeding groups). Parents aren’t interested in the Diploma that I have, or the ongoing CPD that I have to fulfil, including regular supervision, or the fact that my CPD is specific to each of my roles within NCT. Parents just want to know what I can advise – what I can do to ‘help’. The honest answer is “nothing”. Because in either of my roles, that is not part of my job description. Advising would indicate that, again, I know best – and I do for me, but not for you. I have being trained as a reflective practitioner, and I have recently realised that I have moments of conscious and unconscious competence – I am, as we all are, a work in progress.

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If I am visiting you, or welcoming you at our group, I will sit and listen to you talk about your options, and maybe offer suggestions. We might talk about how you feel about what you’re being asked to do, until you come up with a plan that is going to work. Reading the previous blog by Maddie, some of her descriptions about working with parents in labour – asking – what do they want to do, how do they feel… This too is how we work. And the general mistrust by other HCPs feels all too real.

As a peer supporter. I might come to your house on day 1, or day 2 after your discharge. Maybe you called, maybe your midwife referred you because she thinks you need a bit more time, someone to sit while you feed, time that she just hasn’t got because her caseload is so much higher. I fill in forms, I offer to register your child with your local Children’s Centre. I will ask you how your birth was (because this might affect feeding). Maybe your Health Visitor has referred you because you are 12 days in and feeding still isn’t ‘right’ for you. Perhaps your baby still isn’t back to birth weight. We have time. I have time to stay to the end of the feed and see how your baby slips down because the cushion could be in a better place…

As a Breastfeeding Counsellor I also have time to sit and listen to your worries about how feeding didn’t work well with your older child. You might have called me because I facilitated your antenatal session; or maybe you’ve been searching on the internet. You might have called the national line, and they have given you my details. Maybe you have come to the Drop In that I run with another colleague. I might visit you at home, where you apologise for going round in circles about whatever is worrying you – but I sit and listen, and reflect your words to you, or maybe ask the one question, or make the observation, that triggers the understanding in you that your worries are not all feeding related, that you’re concerned about your relationship with your partner.

I too go home and worry; did I say enough, not enough. Did I miss a subtext. I am all too aware of the responsibilities that the midwives and health visitors have. The understaffing, overstretching. We will refer in parents who are struggling. “If you are still concerned talk to your midwife, is this something you feel you can ask your Health Visitor about…”. We will make the phone calls where we are concerned about parents mental health, those feelings where things just feel slightly ‘off’. We trust that you will support families, and we ask that you trust us to do the same. Trust that we have the experience with breastfeeding, that we can and do support mothers long after they stop attending baby weighing clinics, long after their regular assessments – all still breastfeeding. We support them to continue, and to stop when that’s right for them. At 2 months, or 2 years, or even longer.

I want (I want?) I can say it in this context… I want all women to have confidence in their decisions, and to have the right information for them to make the decisions that work for their family. Whether that is because they understand that breastfeeding past 9 months isn’t tantamount to child abuse (yep, that old chestnut); or whether it’s because I signposted her to the information they needed about their anti-depressants which meant they had confidence in continuing to feed even when she felt her world was falling apart. Whether that’s because we worked on positioning until she finally hit that sweet spot and it finally clicked that no, breastfeeding does *not* have to be painful; or whether after seeing 6 other HCPs and being told that she had ‘forgotten’ how painful feeding was, I mentioned tongue tie as another possibility, and lo and behold division did result in huge improvements. We have time, I tell the women I see, don’t worry (often as I’m glancing at the clock, thinking, I’m going to be late to my last visit, and I know that’s 20 minutes away, and it’s already 4.45pm on Friday, and I finish in 30 minutes). When baby won’t latch, or has just fed before I arrived and won’t be woken. “How have things been?” “What have you tried?” “Some parents find…” I joke that all babies sleep for me, except my own. We talk about previous miscarriages, we talk about the joy in feeding her firstborn, and the fear that it won’t work this time. That she’s been told it’s just a “small” tongue tie, but she’s worried about him swallowing blood; we talk about how to deal with engorgement, and how can she ease the cramps that accompany her let down. How can her partner bond with baby, so when can she start expressing; we talk about shared bath times, and babywearing. And how will she cope when he goes back to work. We have such a fluid society that we don’t often live close to our mothers, and can’t learn from them the way we used to. My visits span the world, from South Africa to Vietnam, to Latvia, Canada or Scotland. The accents change but the worries and fears are all the same.

It gets easier, you can do this. And particularly in the light of the media frenzy unleashed by the Breastfeeding Series published by the Lancet. We can do this. Together we can change the world.

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A message for GPs: when a breastfeeding mother walks through your door…

This post first appeared on Emma Pickett’s own website.  Emma is a Lactation Consultant supporting families in North London, and Chair of the Association of Breastfeeding Mothers. She has kindly agreed to let us share this excellent post on #MatExp.

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You may have seen the Lancet series on breastfeeding that was published last week [1] and you may have seen the headlines that announced the UK was the “world’s worst at breastfeeding” [2].

It’s a time when those of us in breastfeeding support feel both energised by the Lancet’s affirmation that breastfeeding matters in all countries: “Our systematic reviews emphasise how important breastfeeding is for all women and children irrespective of where they live and of whether they are rich or poor”. [3] And also disappointed that the media’s emphasis was on UK ‘failure’ and it quickly turned to the ‘failure’ of individual women. [4]

As Dr Rollins stated at the launch of the Lancet papers, we need a different focus: “This is not about individual mothers either succeeding or failing. This is not about one lobby group winning over another; it´s not about our individual comfort zone or fashion; it´s about the survival and health of women and children today and in future generations” [5].

These are big issues and they require big thinking and money. At a time when money is hard to find. Health visiting and community breastfeeding support have moved to local authority funding from NHS England and these are the same people looking to save significant chunks from their budgets. There is a local authority in London threatening to decommission health visiting services in 2017. Peer support services are being slashed – even the ones run by volunteers [6]. Children centres are closing and the few groups run by volunteers are struggling to find places to meet [7] Infant feeding coordinator positions are being lost. There is no breastfeeding lead or national committee on breastfeeding in England and the post of Welsh lead has just been cut.

Things are about to get very real for GPs in the world of breasts. Imagine a mum giving birth and being discharged by the community midwife (already stretched and unable to give sufficient time to breastfeeding support) and then when breastfeeding goes pear-shaped after 10 days, the GP is her only port of call. If I had a pot of money to spend on breastfeeding support in the UK right now, I would spend it on talking to GPs about breastfeeding. In a country where the infant feeding survey is cancelled, helplines running on a shoestring, health care professionals being trained by formula companies [8], I’d still spend it on talking to GPs. If I had unlimited time too, I would buy every GP a coffee and say, ‘Can I just have five minutes of your time to tell you a handful of things that will change lives?’

Health care professional bashing is a national pastime. Right after the breath where we say how proud of the NHS we are. But please don’t imagine that those in breastfeeding support don’t get how hard this is. You have ten minutes to talk a mother who is presenting with complex issues wrapped up in emotions and sleeplessness with a chaser of internet research. You have to be a generalist and the lactation bit really wasn’t a focus in your training. We understand that and we’d like to correct that but now you are in your surgery and working a day that doesn’t give you time to go to the toilet, we get that ship might have sailed.

Before you move onto your next webpage, please skim this one. I am an IBCLC, International Board Certified Lactation Consultant. That means I took two 3 hour exams after a thousand hours of supporting breastfeeding mothers. And I recertify every 5 years after a further 75 hours of education in lactation. I am chair of a national charity (http://www.abm.me.uk) that helps to run the National Breastfeeding Helpline and have spoken to more than 3000 mothers myself on that helpline. I run three drop-in groups in North London and have done for seven years. I visit mums in their home and spend all day texting, emailing and phoning to discuss breastfeeding issues. I don’t know everything but I do know what is likely to walk through your surgery door and what will be helpful for you to say to them.

Mothers need help with medication. They want to continue breastfeeding and treat their other conditions. They don’t want to stop breastfeeding for even a day. That’s like asking them not to be a mother when breastfeeding really matters to them. It is hard to get reliable information on the compatibility of breastfeeding and medication as manufacturers will have rarely paid for the necessary licensing for breastfeeding mums and the responsibility is pushed back on to you. Luckily in the UK, we have other people who will take that responsibility. The Breastfeeding Network runs the Drugs in Breastmilk helpline: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/.

The factsheets on this site give a summary of the main medications for a range of conditions. The compatibility of anti-depressants and breastfeeding may be especially relevant to some of the new mums you see: https://www.breastfeedingnetwork.org.uk/wp-content/dibm/anti-depressants-oct14.pdf.

Research has shown that ending breastfeeding can increase risk of postnatal depression so supporting mums to use medication that is compatible is an important role of the GP [9]. As well as using the factsheets, you or the mother can contact the helpline directly to speak to a specialist pharmacist. The ‘Breastfeeding and Medication’ page can also be found on Facebook:https://www.facebook.com/breastfeedingandmedication/info?tab=page_info. Messages are answered by trained volunteers

Mums walk in the door with mastitis. Let’s just check first it’s not a blocked duct that can be resolved with good self-help measures. A blocked duct means firmness and even tenderness in the breast but the mother feels generally well and there is no pyrexia. This can be resolved with increased drainage of the breast, warm compresses on the firm area and massage. An electric toothbrush is handy for massaging the affected area. The mother may benefit from using different positions to help with draining the breast effectively or pumping after a feed if there is concern the baby is not feeding well. If infective mastitis is suspected, antibiotics should be accompanied by increased drainage and the massage and warm compresses. If a mother does not continue to breastfeed frequently, it is more likely she will go onto to develop an abscess. Obviously antibiotics should be a last resort for a number of reasons, not least because the dyad may go onto develop nipple and breast thrush as a consequence. https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BFN_Mastitis.pdf 

​Mums will walk in with sore and damaged nipples. This may sometimes be the entry point for the staph aureus which is the common cause of mastitis. The most common cause of nipple damage will be positioning and attachment issues. Of course, in the ideal world, you’ll be referring a mother to a breastfeeding support group, a lactation consultant or a trained health visitor. However there are things that take less than three minutes to point out that could make all the difference. Is the mum leaning forward to ‘put’ the breast in the baby’s mouth or moving the breast unnaturally (so then inside the baby’s mouth it springs back into its natural position and gets trapped against the baby’s hard palate)? Damage is likely to be caused by nipple abrasion against the hard palate usually because the baby does not have enough breast tissue in its mouth. The baby’s gape is important. And when the baby gapes, we want to maximise the space of their tongue on the breast. Their chin should be making close contact, the baby’s body close, the baby not likely to drift if mum’s arms get tired. We want the baby to take a large mouthful of areola below the nipple. This lactation consultant explains how simply leaning back can make all the difference and the fact we falsely believe a mother should sit bolt upright is often the problem:

“In the commonly used cradle, cross-cradle, and football/rugby holds, mothers and babies must fight the effects of gravity to get babies to breast level and keep their fronts touching. If gaps form between them (which can happen easily with gravity pulling baby’s body down and away), this disorients baby, which can lead to latching struggles. The pull of gravity makes it impossible for a newborn to use his inborn responses to get to his food source and feed…In these positions, gravity can transform the same inborn feeding responses that should be helping babies into barriers to breastfeeding. Head bobbing becomes head butting. Arm and leg movements meant to move babies to the breast become pushing and kicking. Mothers struggling to manage their babies’ arms and legs in these upright breastfeeding holds have often told me: “I don’t think I have enough hands to breastfeed.”
http://www.mothering.com/articles/natural-breastfeeding/
These videos shows a powerful alternative:
http://www.nancymohrbacher.com/videos/And this image from Nancy Mohrbacher may help

Picture

​Latching issues can also cause vasospasm and blanching of the nipple. It can also be responsible for neuralgia deeper in the breast. A mother with Raynaud’s syndrome may experience nipple pain when breastfeeding is otherwise going well. She may find applying warm dry compresses after a feed helpful and in severe cases nifedipine can be prescribed:http://www.raynauds.org/2011/02/08/help-for-pregnant-breastfeeding-moms/

If it’s not an issue of latching, you may be prescribing topical antibiotic cream or considering treatment for thrush: https://www.breastfeedingnetwork.org.uk/wp-content/dibm/thrush-oct14.pdf

Thrush will usually develop after a period of pain-free breastfeeding. If a mother is getting misshapen nipples after a feed and the nipples appear to show mechanical damage, latching will remain the primary focus. Even in the absence of symptoms, both members of the dyad will need thrush treatment if one is suffering. Miconazole oral gel is not licensed under four months due to a risk of choking but mums can be taught to apply the gel safely and it is shown to be more effective than nystatin suspension. Deeper breast pain is often connected to neuralgia but ductal thrush is a possibility. The pain will develop as the breast empties and peak shortly after a feed (or pumping session) has finished. Fluconazole is not licensed for breastfeeding mothers. However it’s worth noting that the amount that gets through in milk is 0.6mg/kg/day. The amount that can be given to a baby within the license is 6mg/kg/day (Dr Thomas Hale).

A mum experiencing constant nipple pain and damage despite support with positioning and attachment and may also have a baby who struggles to stay attached, feeds for excessively long and may feed frequently, isn’t putting on weight adequately, could have a baby with ankyloglossia (tongue tie).  An overview here: http://www.cwgenna.com/ttidentify.html. Posterior sub-mucosal tongue ties can be particularly difficult to identify on first look. You should have a referral pathway that gives you access to a tongue tie clinic locally:http://www.unicef.org.uk/BabyFriendly/Parents/Problems/Tongue-Tie/Tongue-Tie—Information-for-health-professionals/.​

A Mother may come for help when they suspect they have low milk supply. Is there anything you can do? It is worth noting that many mother lack confidence and perceive themselves to have low milk supply when they are experiencing normal breastfeeding:  http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/low-milk-supply-101

If a mother’s breasts are feeling softer, if they no longer leak, if their baby is not sleeping for extended periods, if their baby is cluster feeding – all that can be normal. As can a mum whose body does not respond to a breast pump and they find it hard to trick their bodies in achieving the surge of oxytocin needed for the milk ejection reflex when a plastic pump is all that’s there to stimulate it.

However if a mother is showing further signs and her baby is experiencing faltering growth, she may be asking you to help. Has she already received good quality breastfeeding support? Has her baby’s positioning and attachment been checked? Is she feeding regularly and not switching sides too quickly (but also not staying on one side beyond the point the baby is transferring milk because someone has mistakenly told her a baby MUST feed for 30 minutes). Could she benefit from hiring a double hospital grade pump to help boost supply? Is she in the process of reducing her use of formula and giving her milk production a chance to develop?

What else could be happening?

The impact of thyroid dysfunction on low supply can be devastating and a significant minority of mothers experience thyroid issues post-partum: http://www.lalecheleague.org/ba/feb06.html.

Some mothers, perhaps those with insufficient glandular tissue, may be asking you for a prescription of domperidone. This is an off-label use of the drug and there have been some concerns with using it for lactation in the last few years. Some research indicated a link between domperidone and cardiac issues. However the issues were among patients over 60 who had cardiac problems, who were taking other medication which caused arrhythmia or were taking a dose of domperidone greater than 10mg three times a day.https://www.breastfeedingnetwork.org.uk/wp-content/dibm/BfN%20statement%20on%20domperidone%20as%20a%20galactogogue.pdf
Research has shown that domperidone causes a steady increase in milk supply over a placebo. As the Breastfeeding Network specialist pharmacist notes, “We do not have research suggesting that domperidone causes risks to otherwise healthy, young women who are breastfeeding.”

Metoclopramide is sometimes prescribed as an alternative prolactin-booster but we need to be aware this is known to increase risk of depression and should only be given for short periods.

Breastfeeding doesn’t feel like a ‘choice’ for many of the women seeking your help.For lots of mums, it is a choice and it might be a choice that they decide not to go for.  That is of course up to them and their families. But for many of the desperate women in pain and struggling, this is one of the most important things they will ever do in their lives. To discuss moving to formula instead of looking at the root of their problems or to discuss your personal views about formula feeding is a waste of precious minutes. You may have struggled with breastfeeding yourself, or watched your partner struggle. It can be difficult to empathise with the woman sitting in front of you who appears to prioritise breastfeeding beyond what you consider logical. It may make you feel uncomfortable about your own choices. Other healthcare professionals may get a chance to debrief their own breastfeeding experience but you rarely do.

Do not doubt that there are women who seek your help who would literally have a toe amputated if it meant that they could solve their breastfeeding problems. And they’d be happy for you to do it right there and then. And that’s about the level of pain they are experiencing right now, but still they persevere. ‘Why don’t you give up?’ is what they are already being told by mothers-in-law and friends and sometimes partners when they cry at 3am. They are asking for your help because that isn’t the way they want to go. When their nine month old is on a nursing strike and is suddenly refusing the breast, they want you to check for an ear infection before you talk about formula. They get it’s an option. Ending breastfeeding and using formula really isn’t a secret. If you don’t know the answers, then it’s valuable to have a sense of what is available to you locally in terms of signposting. Your local health visiting team should have information available on local support groups and drop-ins. What leaflets does the local post-natal ward give out? There are four charities in the UK that offer breastfeeding support: the NCT, the Breastfeeding Network, the Association of Breastfeeding Mothers and La Leche League. Is there a local La Leche League meeting near you?

If you aren’t familiar with local drop-ins, mums can also speak to breastfeeding counsellors through the National Breastfeeding Helpline: 9.30-9.30 365 days a year on 0300 100 0212. All the charities have their own separate helpline too.

If a mum needs more specialist care, a lactation consultant may be useful. An IBCLC may be attached to the local hospital or they can find one at http://www.lcgb.org

They may also be women breastfeeding past 12 months and even 2 years and 3 years. They are doing that because they are meeting their child’s needs and their knowledge of the constituents of breastmilk and its continuing immunological benefits may possibly supersede yours. If you are personally uncomfortable with it, it’s not a conversation you need to have. Do you believe that breastmilk ‘loses its benefits’ as time goes on? What is your evidence-base for that belief? Can you find its source?It looks as though the role of GPs in lactation support is likely to become even more significant in the coming years. There are places where you can access more training. UNICEF have an e-learning package that you may find useful:http://www.unicef.org.uk/BabyFriendly/Resources/Training-resources/E-learning-for-GPs/

Or here from BMJ learning: http://learning.bmj.com/learning/module-intro/breast-feeding.html?moduleId=5003232 
You can also find free videos here: http://www.health-e-learning.com/resources/free-lectures?lang=en
Shadowing a lactation consultant or a breastfeeding counsellor at a support group will also be a valuable way to spend some time.As the Lancet series says, ‘breastfeeding is generally thought to be an individual’s decision and the sole responsibility of a woman to succeed, ignoring the role of society in its support and protection.’ [10]. Those of us who talk to breastfeeding women every day know we cannot underestimate the impact of just 10 minutes of contact with a well-informed GP. The effect is felt in her immediate relief as she walk away from the surgery and in the lifelong impact on her and her baby’s health.Notes:
[1] http://www.thelancet.com/series/breastfeeding
[2] http://www.bbc.co.uk/news/health-35438049
[3]Victora, C.G. et al (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90.
[4] https://heartmummy1980.wordpress.com/2016/02/03/are-you-strong-enough-to-change-the-world/
[5] https://www.facebook.com/DrJackNewman/
[6] http://www.essexchronicle.co.uk/Essex-County-Council-cut-support-breastfeeding/story-28078350-detail/story.html
[7] http://www.bbc.co.uk/news/uk-england-wiltshire-34983055
[8] http://www.babymilkaction.org/archives/7167
[9] http://www.cam.ac.uk/research/news/breastfeeding-linked-to-lower-risk-of-postnatal-depression, http://www.ncbi.nlm.nih.gov/pubmed/25138629
[10]
Rollins, N.C. et al (2016).  Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387: 491-504.

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Top Ten Things NOT To Say To A Preemie Parent

Language is a huge theme for #MatExp, and one of our six Heart Values.  Francesca Tucker kindly agreed to write this post for us looking at people’s inadvertent language trip ups when talking to parents of premature babies.  Francesca is a part-time working Mum, who lives in the New Forest with her husband Murray, baby Harry and their three cats. Harry was born at 28 weeks, whilst his parents were on holiday in France. He’s now a happy, healthy 18 month old!

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As I sit and write this now, I can do it with a smile on my face.  But 18 months ago, if you’d said any of the following “Top 10” to me, my reaction would have been vastly different.  Depending on how my day had gone / how many Brady’s baby Harry had decided to scare us with / how much milk I’d managed to express etc., you may have had a response of tears, anger or stony silence. Because, quite frankly, there are just some things you don’t say to the parent of a premature baby!

Speaking on behalf of “The Premature Club” which no-one wants membership to, we understand that it’s difficult to know what to say.  The pure joy of the newborn news is tinged by the elephant in the room- “what if they don’t make it”?  We know that as our family, friends and loved ones you are thinking of us (we do appreciate it!) and you want to say the right thing, but we’re not expecting you to – there are no magic words that will break the spell and make everything better.  Just being there for us, letting us cry, shout, or just sit in silence helps.  And that silence can be golden – far better than the following “Top 10 Things not to say to a Preemie Parent”! (As compiled by myself and another Prem-Mum whilst we were in neonatal, both with boobs out, trying to get our babies to practice their breastfeeding!)…..

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1. You’re lucky!  You got to meet your baby early!

Yep, at this time, we’re feeling really lucky-said no-one EVER!  Last time I checked, there was no calendar hung in my uterus, so I’m pretty sure the baby had no concept of ETAs.

2. Your baby was just keen to meet you.

I was creating quite a nice little home in my womb which I was quite proud of- food on demand, good thermostat, nice sounds, and a lovely landlady who was providing everything.  I think my baby was quite happy to stay put for a while longer, and wasn’t that eager to meet me. He/she had heard me chatting enough already, so I’m pretty sure the baby knew me already!

3. Oooh, having such a small baby must have made labour easy!

Putting aside the obvious fact that childbirth is painful, what a lot of people forget is that Prems often arrive in emergency situations. This may involve tearing, C-sections, episiotomies as well as the wider delivery tool-kit of forceps, ventouse etc.  This is NOT easy! (And don’t even get me started on the emotional aspects of labour)

4. Lucky you!  You’ve got less baby weight to lose!

Why is it that when someone has a baby, everyone feels it’s acceptable to start commenting on your weight?!  It’s no-one else’s business that you weigh, it’s the last thing on your mind whilst listening to the endless beeping in neonatal. And chances are that with the stress of the situation, you’ll be losing weight anyway

5. Well, at least with the baby in hospital, you get a good night’s sleep!

Erm, no!!  At night, most Prem parents are trying to cram in a day’s work of general life into a couple of hours (unfortunately bills still need to be paid, housework done etc.), prepare supplies that need to go to the hospital the next day, express milk through the night to keep supply up, and are generally stressing.  A good night sleep is not anticipated for months!

6. With those nurses around, you’re getting far more support than most Mums.

Yes, the nurses are a fantastic support (they become your extended family!), and it’s a hard job to do, but they are by no means doing it single-handedly.  They encourage the parents to get involved wherever and whenever possible. I can’t think of many parents that have a baby just to hand them over to someone else to look after – you are the parents, and you want the job!  But also remember, the medical team is desperately needed- many Prems need a lot of medical support…surely no-one can begrudge a baby that?!

7. But tiny babies are so cute!

True, but would you swap your baby being dangerously small for “cute”?  I thought not.  And trying to find the “adorably small” premature outfits is tricky…and very expensive!

8. When will the baby be coming home?

We don’t know, and if we do, we often won’t want to say.  It is upsetting thinking you’re about to take your baby home, only for your child to take a downturn and your excitement turns to disappointment and fear.  Sometimes it’s easier for the parents to say nothing, rather than having to explain why the baby is remaining in hospital.  And when we finally take our little family home, we may well want a day or two to take it all in-it’s a long journey to get home!

9. How are you doing?

Mmmm, a tricky one.  Some days will be good, some days will be bad.  With 1001 thoughts and emotions running through a Prem parents head, it’ll probably take too long for them to give an honest answer- default option is option to be “Okay, thanks. You?”  A better thing to say if the offering of help for a specific thing e.g. “Would you like me to bring you a meal around, so you don’t need to cook?”

10 Will he/she be okay?

A very personal question, and again one that is completely dependent on individual circumstances.  Define “okay”?  The baby may have long-term health issues, but with the prospect of excellent quality of life, the outlook is overall positive.  Or the baby may be going through a serious complication, where the outcome is an unknown. No-one wants to answer “No, he/she is not okay”, as it’s upsetting for all concerned.  I personally think such questions are best avoided, and simply substituted by as much love and support as you can provide.

Harry

These are some of the favourite options I had for you from our early days of the neonatal journey.  Now, a favourite is “Isn’t he walking yet?” – nope! But bear in mind, his peers have a 3month developmental head-start!  Maybe I should do a Top 10 comments for the “Advancing Prem Baby”?!……….

But to anyone reading this, currently supporting a neonatal family – thank you.  Even though the family may not show it (they are probably too overwhelmed presently), having you present in their lives is helping them more than you’ll know.  And if you’re the parents of the little baby/babies lying in hospital- I welcome you to “The Premature Club”- it’s tough, and at times you may feel so wholly overwhelmed it can engulf you.  But remember, you are doing a great job and making the best of your situation. I send my love and support to you.

By Rosiepics
Francesca and Harry by Rosiepics

Francesca Tucker

2016

For more “What Not To Say” and other Preemie Top Tens please visit The Smallest Things website.

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It is time to talk about the ‘perinatal’ aspect of Perinatal Mental Health (PMH): the ‘missing link’ in the national campaign

I am delighted to be able to publish today a guest blog for the #MatExp campaign from Mr Raja Gangopadhyay.  Raja is a Consultant Obstetrician and Gynaecologist with special area of clinical interest in Perinatal Mental Health (PMH) from West Hertfordshire Hospitals NHS Trust. He is a member of the Royal College of Obstetrician and Gynaecologist (RCOG).

Raj capture

I would like to take this opportunity to share my views on why I feel so strongly about the role of the Maternity Services in Perinatal Mental Health (PMH).

Perinatal Mental Health (PMH) has two important components in its terminology: ‘Perinatal’ (period during pregnancy, delivery and post delivery) and ‘Mental Health’. Therefore the care of mums in the Maternity Services during this vital period is of utmost importance in PMH: it should be a no-brainer.

But sadly, PMH is the only one area of Maternal Health where I do not see a strong voice of the Maternity Services in the national campaign.

This has remained ‘Cinderella’ within Maternity Units in spite of the glaring facts:

  • PMH is still one of the leading causes of maternal death in the UK.

  • This is one of the most prevalent conditions mums suffer from during their pregnancy and postpartum period (at least 10% of mums suffering from this).

I strongly believe that without robust ‘perinatal’ care, women would continue to suffer and die from PMH illnesses, no matter how much we spend to expand specialist Mother and Baby Units (MBUs).

Therefore this is the time when we must recognise this important area and raise awareness.

I am trying to address this issue through my campaign on social media and as the Royal College of Obstetrician and Gynaecologist’s (RCOG) Representative to the Maternal Mental Health Alliance (MMHA).

What do I mean by PMH ‘within’ Maternity Services?

Suffering and deaths from PMH illnesses are often preventable if appropriate measures are taken during pregnancy and in the immediate postpartum period.

A prevalent health condition like PMH must be managed with the same readiness as managing other medical conditions in pregnancy such as diabetes, high blood pressure (pre-eclampsia) or heart disease.

The only way to ensure that the women with PMH are appropriately cared for according to the NICE guideline (2014) is to have:

  • A dedicated PMH team within every Maternity Service:

A Consultant Obstetrician, Specialist Midwife, a Perinatal Psychiatrist, a Specialist Psychiatry Nurse and a Paediatrician should jointly lead this service locally. The service should be easily accessible to the mums.

  • A dedicated Obstetric-Psychiatry Antenatal clinic

  • Communication with Community Team:

This Maternity Service should have clear links with GP, Health Visitor (HV), community MH Team, Liaison Psychiatry services, Mental Health Crisis Team, Children and Young People services, Peer Support groups and other charitable organisations.

  • Robust Care Pathway:

There should be a clear pathway for risk assessment (at the booking visit and at every consultation), early identification and treatment. There also should be provision of a multi-professional team meeting on a regular basis.

  • Dedicated specialist service and support:

For conditions such as PTSD / birth trauma, fear of pregnancy and child birth (‘tocophobia’), bereavement and support for mums and dads whose babies are admitted to NICU.

  • Pre-pregnancy advice service:

It is important to have specialist advice and support for women (with PMH illness/ traumatic experience in previous pregnancy) who are considering pregnancy.

  • Patient involvement : ‘Patients first and foremost’

PMH is an area where patients’ opinion must be considered in developing local care pathways. Services must be evaluated on a regular basis based on patient experience.

I firmly believe that all the health conditions should be treated in the same way with professional expertise and kindness and without any prejudice. I am not sure why we still classify health conditions into ‘physical’ and ‘mental’ when there is often an overlap.

Psychological care in pregnancy, delivery and beyond…

It is unfortunate that psychological care has remained a very neglected part within Maternity Services. The reason given for this is ‘the staff are too busy’.

However pregnancy is probably a period of life where psychological support from the HCPs is needed the most.

It is especially important when mums could potentially have severe stress during pregnancy and the postpartum period due to the following factors:

  • Previous history of miscarriage, ectopic pregnancy, IVF, traumatic childbirth.

  • Any other family member or friend has had complicated childbirth experience.

  • Sudden life event such as breakdown in family relation/divorce, loss of employment, bereavement in the family or loved one, relocation/migration and domestic violence.

  • Sexual abuse in childhood or pregnancy as a result of sexual violence.

  • Associated pregnancy complications (for example premature rupture of membrane, high blood pressure, diabetes, concerns on baby’s growth or SPD).

PMH is not only PND and Puerperal Psychosis (PP)…

Many believe that PMH is a term equivalent to the care of Postnatal Depression (PND) and PP.

PMH includes specialised care for women (during pregnancy and one year after the childbirth) with any mental health condition (such as anxiety, depression, bipolar illness, schizophrenia, OCD, eating disorder, and personality disorders).

PMH must include bereavement care (miscarriage, still birth and neonatal death), traumatic birth experience/PTSD, support services for mums and dads whose babies are admitted to NICU and tocophobia (fear of pregnancy and childbirth).

Another important component should be the psychological care of mums and dads throughout the journey of pregnancy, delivery and postpartum period.

PMH, in my view, must be recognised as a separate subspecialty in the training of Obstetricians and Midwives.

Womb

Why is identification in pregnancy and immediate postpartum period so important?

  • Effects of psychological stress in pregnancy:

There are now plenty of research results, which indicate the long-term impact of stress during pregnancy on the brain development of the baby while it is in mum’s womb. Prof Vivette Glover, an eminent Professor of Perinatal Psychology from Imperial College London, explains this: http://www.beginbeforebirth.org/for-schools/films#womb

Therefore timely intervention and adequate support during pregnancy can prevent long-term effects on the child.

  • Care Planning to prevent serious illness:

All pregnant women with risk factors to develop worsening mental health conditions should have a plan of care during delivery and postpartum period.

Confidential Enquiries into Maternal Deaths have repeatedly pointed out that in the majority of cases of deaths from suicide, there is a lack of care planning during pregnancy.

This is only possible through appropriate care within the Maternity Services and multiagency communication.

  • Enjoying the journey of pregnancy:

Experience of pregnancy and birth creates a lasting memory for the mums and dads for the years to come. Therefore this should be an enjoyable experience for the woman and her family to cherish in happiness in the future.

As HCPs our role is to ensure we support and empower women to make informed choices for the safety of her and the baby and most important of all a very positive birth experience.

  • Helping mums to make informed decision regarding medications:

Mums should get proper advice regarding the use of medication in pregnancy and after delivery.

Pregnancy is a short window but an excellent opportunity to address health conditions.

  • Bonding and attachment:

PMH conditions can adversely affect the bonding with the baby and the mum.

‘A stitch in time saves nine’: Prevention of serious PMH illnesses is only possible through good care in Maternity Services.

Guardian capture

Having discussed the importance of the role of Maternity Services in PMH, now let us find out what is happening in the Maternity Units……

A journey of revelations…

I contacted many Maternity Units across the country to find out the provision of PMH services within their Units. What I found was extraordinary.

I raised my concerns in a letter published in The Guardian: http://www.theguardian.com/society/2015/oct/14/perinatal-mental-health-provision-badly-lacking .

I raised this issue with the Maternity Review Team, during my meeting in September (2015).

Although there are examples of good service, the overall structure within the Maternity Units is very poor:

  • Often there is no dedicated Lead Obstetrician and/or Specialist PMH midwife

  • Many Units do not have formal debriefing services (for traumatic birth experience), specialist bereavement midwives and support system for parents with babies admitted to NICU.

  • There are hardly any dedicated services for women with fear of childbirth.

Delving deep into the challenges….

To have a better understanding of the need, I embarked on a journey to meet professionals from all the relevant Royal Colleges (RCOG, RCM, RCPsych, RCGP), Health Visitor organisations, Maternal Mental Health Alliance (MMHA), MPs and All Party Parliamentary Group (APPG), NHS England, CCGs and other national Campaign Groups.

It was revealed that overall there is very little understanding of the vital role of the Maternity Services in PMH.

Thankfully RCM is campaigning for a Specialist Midwife in every Maternity Unit.

But the main barriers are the following:

  • Lack of Mapping of the existing services in PMH within Maternity Units (such as the MMHA map of the available Perinatal Psychiatry services).

  • Lack of a national standard of the service provision within Maternity Units (according to the number of deliveries and complexity of cases).

  • Poor collaborative work among HCPs: as often the Maternity Electronic record system is not accessible to other HCPs and vice versa.

  • Lack of standard Training programme for the Obstetricians and the Midwives.

  • Lack of adequate focus on PMH illnesses in Antenatal Education.

I have concerns that unless these issues are resolved appropriately, we cannot provide the best quality of care for women with PMH illnesses.

With the best of my abilities, I am currently working closely with other national organisations to address these areas.

Maternity HCPs: Please, please do something and don’t wait for things to happen….

Charles Dickens

It is true that funding is necessary to set up specialised PMH services and Mother and Baby Units (MBU). However Maternity Units should not wait for the approval of their business cases.

In my humble opinion, funding is not everything. Our professional values are the most important factors in patient care:

  • Kindness:

Simple measures such as a smile, empathy and a willingness to listen to the concerns of the mums and dads could make a huge difference in patient experience.

  • Communication:

Take every opportunity to explain the situation and ensure that appropriate wording is used during communication.

  • Continuity of care:

Try to ensure continuity whenever possible or communicate adequately with the rest of your team.

  • Local Alliance:

Please try to develop Local Alliances with Community Midwives, Health Visitors, GPs, all available community mental health services, Peer Support groups and children’s services.

This could significantly improve communication among the multi-agency teams in caring for mums with PMH illnesses.

  • Listen to concerns:

Please create opportunities to listen to the concerns of the user group. This may be in the form of promoting your local Maternity Service Liaison Committee (MSLC) or Patient Panels.

If possible, please read the real life stories of the Lived Experiences on the Internet: it would help you to think ‘outside the box’, have a better insight into the PMH illnesses and give you inspiration.

  • Raise awareness:

Arrange patient engagement events, Road shows or Community Events with local CCGs.

Participate in Social Media support, such as #PNDHour (Wednesday 8-9pm) and #BirthTraumaChat (Monday 8-9pm):

This would help to raise awareness, remove stigma and give mums and dads a ray of hope.

  • Arrange training on PMH:

Please ensure all staff are adequately trained in your local Units.

  • Get involved in your Regional PMH network:

Many regions now have regional PMH Networks. This could be an important place for information sharing among the Maternity Units.

  • Please do not forget dads:

There is now good evidence to support that dads can suffer from PTSD/PND. Please take every opportunity to support and communicate with dads.

  • Keep yourself updated:

PMH is a rapidly evolving area; therefore HCPs must keep their knowledge and skills up-to-date through continuous professional development.

If unsure, please seek help and escalate to your senior colleagues: an unsafe advice from a HCP could endanger an invaluable life.

Working together to make a difference…

We ALL need to work together to prevent suffering and death from PMH illnesses.

If you have any suggestions for improving PMH services within Maternity Units, I would be very keen to know (Twitter: @RajaGangopadhyay3).

If you are involved in good projects locally or are aware of any good practice, please share with everyone through #MatExp.

Acknowledgement

I am grateful to #MatExp for giving me this opportunity to write this blog.

I am immensely grateful to all the Lived Experiences for sharing their stories, which have enriched my knowledge on PMH much more than any textbook and journal article.

My thoughts are with all the bereaved families who have lost their loved ones due to this dreadful illness.

Raja Gangopadhyay

2015

 

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Health Visiting & Midwifery – A Partnership

I have great pleasure in sharing with you a guest blog from Health Visiting Lecturer Charlotte Smith and Midwifery Lecturer Neesha Ridley – a great team from UCLan.

Following our wonderfully informative Twitter chat last week, we were asked to contribute to the MatExp blog – what an honour, thank you!

We are writing as a partnership, because this is what we believe health visiting and midwifery should be. To explain, “We” are Neesha and Charlotte, a midwife and health visitor (in that order!) who recently found ourselves united in a number of ways.

First, we are new to our roles as lecturers at the University of Central Lancashire. We enrolled on our teaching course together, thus embarking on our new career journey together – joint working together is enjoyable, time saving, cost effective and efficient, and our shared “newbie” status allows us to express our vulnerabilities and successes openly with each other. (Also, we discover we have a similar sense of humour which is always a bonus!)

Second, our passion for joint working was discovered when Neesha asked Charlotte to come and speak to midwifery students about the role of the health visitor. Neesha had been aware of the importance of MDT working in the childbearing continuum and had organised a succession of guest speakers, designed to give Midwifery students the knowledge and experience of the services they will work alongside in the “real world”. Charlotte leaped at the chance, and went along to the session prepared to outline the role of the health visitor.

What neither of us had been prepared for was the response. Armed with insightful questions and an obvious desire to learn more about their health visiting colleagues, the midwifery students described the need for closer relationships between the two disciplines, and the lack of opportunity in practice to facilitate this.

On feeding this back to the health visiting students, Charlotte had exactly the same response. Why aren’t we being taught with midwives? Why do we not have relationships with our colleagues if we are to work in partnership with them? Why is it that the first time we “properly” meet a midwife is when our training is over? How are we supposed to understand each other’s roles if we learn completely separately?

Our engagement in the Twitter chat around this issue last week confirmed that parents themselves value consistent, seamless support from services in the perinatal period. It also confirmed that at best this experience was inconsistent across the UK.

Just as it is a privilege to be involved in the journey of new parents and the arrival of their baby in the world, so it is equally a privilege to be part of the journey of a new midwife and health visitor into qualification. As we reflected on and evaluated these sessions together, it occurred to us that there were synergies between the two experiences – and it made sense to us that like in every issue in the 1001 critical days, the answer lies in early intervention.

As lecturers, that means introducing the two disciplines in a more facilitative, educational experience during education. In practice, this could be mirrored by a home or clinic joint contact between health visitor, midwife and the family during the antenatal period.

It is well documented that antenatal contacts are significant in improving the health outcomes of women, children and families – we are currently collating the evidence in a paper on exactly this subject. We are very aware that there are organisational and strategic challenges to this proposal, having worked at the coal face for some time and recently, and from listening to our students, and to the views of parents and commissioners. However our third area of unity is this – we have a duty to our professions and to our students, and above all to the children and families who experience our services. We have the privilege of being on a journey with inspirational, committed and dedicated students and we owe it to them to provide the experiences that they identify as facilitating best practice. As a result we are working together not only to influence the curriculum to include structured facilitative relationship building and education between our two professions, but to encourage students to take responsibility for ensuring they maintain this out in the real world.

Not every family would appreciate a joint visit from services – nor might it be economically or organisationally feasible in some cases. But if we educate and practice ourselves as separate, uncommunicative services, families will continue to see us as such. With more conjoined education and more solid relationships from the outset, at least families will have the choice.

Charlotte Smith, RN, HV

Neesha Ridley, RM

TeamWork

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#OxyOct BOOM! What have we all made happen?

Leigh Kendall opened this month for #MatExp with a call to action for Oxytocin October. The campaign is always action focused and we are keen to hear from anyone who is doing something to improve maternity experience in the UK, be it something big or something small. Yet we had already put together a number of blog posts with calls to action, back in #FlamingJune. So I decided that my action for this month would be to revisit those blog posts and find out what progress has been made.

Flo Collage

The original blog posts were on these subjects (each subject links to the relevant post):

Having re-shared the posts on Facebook and Twitter I was delighted to see the responses coming in detailing what has changed, what has been started and what is continuing to be done. Take a look!

Perinatal Anxiety

Sarah McMullen of the NCT explained that she invited Emily Slater (MMHA Campaigns Manager) to speak and run a workshop at the NCT national conference – to raise awareness and inspire action. Sarah says that Emily’s plenary talk to 600+ staff, practitioners & volunteers “was incredibly powerful, and we’re meeting to discuss next steps for NCT”. Sarah added “We’ve also submitted two funding applications relating to mental health awareness (thanks to Rosey Wren for support), and have match-funded a PhD studentship with the wonderful Susan Ayres on Birth Trauma, and are supporting another PhD research project on group identity and PTSD”

Midwives on Twitter commented:

Anxiety capture Deirdre

Anxiety capture Jeannine

To read Jeannine and John’s blog post please click here.  “You matter. I care.”

Emotional Wellbeing

Birth Trauma Chat

#MatExp team member Emma Jane Sasaru has been incredibly active over the last few months.  She has launched Unfold Your Wings a place of information and support aiming to raise awareness of Perinatal PTSD, birth trauma, reduce stigma and give sufferers hope.  She has also launched a CoCreation Network community around perinatal mental health.  Emma has then collaborated with #MatExp team member Susanne Remic to bring about a weekly #BirthTraumaChat on Twitter run jointly from Unfold Your Wings and Maternity Matters.

Sue Henry

Also launched this month by West London Mental Health NHS Trust was this fantastic short film about perinatal mental health: https://vimeo.com/143359951 This film has already sparked many useful conversations.

PMH

Continuity of Care

I was speaking to a commissioner from Cheshire this month about the decision to commission OnetoOne Midwives. The company has this month posted an overview of their caseloading model: http://www.onetoonemidwives.org/_news/caseloading-midwifery-an-ever-evolving-model-of-care

In her talk at a recent National Maternity Review event, Baroness Julie Cumberlege made it very clear that the call for continuity of care is being heard by the review team up and down the country. Neighbourhood Midwives led a discussion at the review’s Birth Tank 2 event, and there were a couple of other discussions where options for continuity were also explored.

Support for Midwives

Poem from banksy midwife @JennytheM:

Midwives JennytheM

Midwife Deirdre Munro celebrated the launch of the new Global Village Midwives website this week. The movement is over a year old and Deirdre explains:

GVM capture

global village midwives

Infant Feeding

Lots of news about infant feeding from passionate individuals and voluntary organisations.  On our #MatExp Facebook group Zoe Woodman explained: “In May we got approval from NCT to run a branch funded feeding support group. Started in June with an NCT bfc attending who is also an IBCLC. We are on 3 boundaries in terms of commissioning services so no local peer to peer style support groups were running within 8miles. The only service is an HV clinic once a week and it’s one on one so you have to wait outside the room to be seen. It’s been on our branch aims at our AMM since I’ve been chair (4yrs!) so finally chuffed to see it in action and I will get to use it myself in January for no3! It’s running twice a month currently but hope we can get funding in the future to run weekly. It’s slowly building in terms of attendance. Feedback so far is great!”

Dorking NCT

Claire Czjakowska’s Breastfeeding Advert is coming together and is looking very exciting – watch this space!  Breastfeeding in Trafford launched its Twitter account this month so please follow for local breastfeeding news.  BfN Portsmouth tweeted:

Bf capture

Midwifery students at the University of Worcester have launched a petition around the questionable practices of infant formula companies – follow the hashtag #WeakenTheFormula for more information.

As if this wasn’t enough, this month has seen the launch of the World Breastfeeding Trend Initiative for the UK.  A committed group of individuals from the major breastfeeding voluntary organisations have come together to measure the country’s performance against the WHO Global Strategy for Infant and Young Child Feeding.  Please visit the website for more information on how this project is structured and the indicators against which the UK will be measured.  The project needs lots of input from families and professionals so please follow @wbtiuk on Twitter and find out how you can help.

WBTI capture

Tongue Tie

Doula Zoe Walsh updated us: “We held a North West tongue-tie workshop in Blackpool. It’s now going on the MSLC agenda for Blackpool so that we can discuss local provision and see if it’s meeting the needs of local families.”  

Breastfeeding and Medications

Friend of DIBM helpline

From a personal point of view, I finally got around to becoming a friend of the Drugs in Breastmilk Helpline this summer.  The helpline is absolutely vital for ensuring that women get the correct information about what medications they can use when breastfeeding.  The service is funded by the Breastfeeding Network and the charity once again asked supporters to do a #TeaBreakChallenge this month to help raise donations.

Teabreak challenge

A wonderful #MatExp collaboration has sprung up this month between Angelique Fox, Sarah Baker and Wendy Jones.  These two #MatExp mums who have never met in person have both volunteered to help Wendy to collect data and raise awareness with regards to drugs in breastmilk, particularly where dentists and podiatrists are concerned.  It was discussed on the #MatExp Facebook group that these two healthcare professions are often cited as not having up to date information about breastfeeding and medications so this collaborative project is aiming to tackle that.

Luisa Lyons, the Infant Feeding Coordinator who wrote our original post on this subject, gave us this fantastic update: “Been a busy couple of months. Infant feeding e-learning training for doctors up and running at my unit and both paeds and obstetricians encouraged to complete it. Great support from our obstetric consultant clinics director too. General paed nurses now doing mandatory infant feeding training every year. Been invited to teach general paed doctors face to face. Three GP’s have done the UNICEF 2 days bf management course with us and now writing bf training for GPs in Norfolk. Included info on bf and medications with scenarios to both student nurses and our midwives at keyworker training now, and incorporating into Mt for all maternity staff. Also off topic slightly am putting in a WHO code game to all the above which has generated lots of awareness with student midwives and maternity staff. Need to join DIBM as a friend which I had forgotten to do, so thanks for the heads up.”

Dads & Partners

Mark Williams, co-founder of Dads Matter UK, wrote this blog post for us for #OxyOct, detailing his work and campaigning: http://matexp.org.uk/matexp-and-me/dads-matter/

Men Love and Birth

Midwife Mark Harris launched his book this month, Men, Love and Birth, “the book about being present at birth that your lover wants you to read”.

A Manchester midwife reported positive outcomes around new rules enabling dads & partners to stay over on her unit:

Dads & Partners Mags

When asked how we can best support Dads & Partners, newly elected NCT president Seana Talbot tweeted:

Dads & Partners Seana

Community Outreach Midwife Wendy Warrington tweeted:

Dads & Partners Wendy

I asked Wendy about the work she does with regards to Dads & Partners and she explained “I talk about attachment and being with their baby, skin-to-skin touch. Antenatal and postnatal depression, and fathers’ role in supporting their partner in pregnancy, birth and beyond and how they can do this. I talk about baby cues and the impact of father’s involvement on child’s future emotional and cognitive development.  I have had excellent feedback from parents and when I see them after the birth they say they felt well prepared for feeling and emotions experienced post birth. They love the fact that I talked about it”

Collaboration between Midwives and Health Visitors

Health visitors on the #MatExp Facebook group told us:

My CPT & I have established 6 weekly meetings with the community midwife and the GP (whose special interest is pregnancy/neonates) to discuss cases”

“We already have that in my team we meet at least once a month with the midwife – it was weekly but we are very busy at the moment (both us and the midwife). She will just knock on our door though and share things – she really came on board with antenatal contacts telling parents to be and signposting those with small children with any worries to us.”

With excellent timing Sharon White, OBE, Professional Officer of the School & Public Health Nurses Association, then tweeted the updated pathway for health visiting and midwifery partnership.

partnership

And as a result of discussing all of this on Twitter, Sheena Byrom has invited me to lead a tweet chat with @WeMidwives and @WeHealthVisitor in November on the subject of midwife and health visitor collaboration.  Watch this space!

Birth Tank

And so much more has been happening in #OxyOct as well! #MatExp was well represented at the NHS Maternity Review’s Birth Tank 2 event in Birmingham – click here for Emma’s round up. I spoke at the launch of the Improving ME maternity review for Wirral, Merseyside, Warrington and West Lancashire – click here for my round up of the morning. Leigh Kendall and Florence Wilcock spread the word at the RCOG Conference on October 16th, and Leigh spoke at the Royal Society of Medicine event on October 20th.

RCOG

Leigh capture

Baby Loss Awareness Week took place this month and many important discussions were had around the subject of grief and loss, something which affects a number of #MatExp campaign members.  Leigh wrote movingly about Standing on the Periphery for #HugosLegacy.

BabyLoss

The RCM has this month launched its State of Maternity Services Report. Emma Jane Sasaru has written a series of three blogs about What Matters in Birth.  Susanne Remic has been raising awareness of IUGR. Michelle Quashie created fantastic word clouds for display in her local maternity unit.  We now have #MatExpHour every Friday created and launched by Louise Parry – click here for her round up of Week 2.  So much going on!

IUGR

I have no doubt there is much much more that I have missed from this round up. There is so much energy and passion in maternity services, and so much desire for change. Whatever it is you are trying to achieve, please join up with #MatExp via Twitter, Facebook or the website and get encouragement and input from like-minded people. Together we are stronger! Feel the Oxytocin flow!

 

Helen Calvert, 2015

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