When I was a kid, I was fascinated by the changes my body was going to go through once I hit puberty and I was on my way to becoming a woman. I was fortunate that my mum was very open about the whole thing, and I felt as though I was better placed, having the idea of puberty presented to me gradually from a young age, than my classmates who suddenly had it thrust open them by the school nurse.
For those of you who need a bit of inspiration, a friend of mine has published a book on Amazon, called Periods and Stuff, and which is available free from the 28th-29th September. Follow this link to have a look, and preview the book.
All she's asking for in return is a review of her book (not obligation). Please download the book, have a read, and a leave a quick review.
Saturday, 27 September 2014
Saturday, 20 September 2014
Elimination Communication
Until I joined a parenting forum, elimination communication was not something I had ever heard of. Whilst it is not something I think I could do, it does fascinate me, as I had wondered how women in the distant past coped with a baby's elimination needs.
Elimination communication is the choice not to use nappies, either all the time or part of the time. Parents observe their baby for the signs that they want to empty their bowels or their bladder. Babies learn to go on command. To me, in some ways, it sounds natural; no other animal wears nappies or urinates and defecates whenever and wherever they wish. On the other hand, a lot of other mammals are unable to pass urine or have their bowels open independently and rely on their mother to stimulate them. It also reminds me of toilet training my dogs - watching for the cues they make when they want to go out and do their business, or alternatively, me sending them out before bed or whenever I want them to go and telling them to 'go wee wees.'
I'm torn by what I want to do when I become a parent. On the one hand, I think it would be lovely not to have to use nappies. On the other, I would worry about picking up the cues, or what would happen if the baby was looked after by someone else.
Elimination communication is the choice not to use nappies, either all the time or part of the time. Parents observe their baby for the signs that they want to empty their bowels or their bladder. Babies learn to go on command. To me, in some ways, it sounds natural; no other animal wears nappies or urinates and defecates whenever and wherever they wish. On the other hand, a lot of other mammals are unable to pass urine or have their bowels open independently and rely on their mother to stimulate them. It also reminds me of toilet training my dogs - watching for the cues they make when they want to go out and do their business, or alternatively, me sending them out before bed or whenever I want them to go and telling them to 'go wee wees.'
I'm torn by what I want to do when I become a parent. On the one hand, I think it would be lovely not to have to use nappies. On the other, I would worry about picking up the cues, or what would happen if the baby was looked after by someone else.
Monday, 25 August 2014
Noise Pollution
I feel sorry for people who live next to noisy neighbours, I really do. I am fortunate enough to live in a quiet village; at night, I occasionally hear an owl, the cows in the nearby field or the flock of birds which seem to love my back garden first thing in the morning. But I love it. I love hearing the sounds of nature. Once, I was disturbed by a neighbour's party and it drove me mad; I had to get up early the next morning for work.
Anyway, the point of this post is this BBC news article. I don't understand the problem here. The resident, who moved to the flat years after the venue started playing live music, is complaining about the noise. He reports the volume has been increased. The owners of the venue deny this. Surely, if someone choses to live next to a pub or club or some other venue which plays live music, then they expect there to be noise. It would be different if the place opened after the person moved in, but it was there long before the resident moved in. Personally, I believe that the resident is the one at fault here and should not cause such a business to be damaged.
Anyway, the point of this post is this BBC news article. I don't understand the problem here. The resident, who moved to the flat years after the venue started playing live music, is complaining about the noise. He reports the volume has been increased. The owners of the venue deny this. Surely, if someone choses to live next to a pub or club or some other venue which plays live music, then they expect there to be noise. It would be different if the place opened after the person moved in, but it was there long before the resident moved in. Personally, I believe that the resident is the one at fault here and should not cause such a business to be damaged.
Sunday, 3 August 2014
Free Birthing
I have been reading up about freebirthing, also known as unassisted childbirth, recently. It is the practise of a woman choosing to give birth without professional assistance, and it is reported to be gaining in popularity in the UK recently, with the recent uncertainty about the future of independent midwifery. However, that problem is now solved, and there is a future for independent midwives in the UK.
In the UK, it is illegal for anyone other than a midwife or doctor to deliver a baby, except in an emergency situation. Doulas should not be present at a freebirth. It is not, however, illegal for women to choose to freebirth.
I have been reading several articles online about freebirthing, and in many have found misused quotes or statistics from sources. Not surprisingly, many of these articles have been written by women who have previously freebirthed.
Whilst these freebirths often happen without a problem, there are a number of risks associated with childbirth which need dealing with almost immediately otherwise there is a risk to the life of mother or baby. A risk during labour is that of cord prolapse. There are a number of factors which cause this to be a risk, and these are anything which prevents the presenting part of the fetus (hopefully the head) descending in to the pelvis before the waters break. These may include an ill-fitting presenting part, such as small fetus, a malpresentation (such as a shoulder presentation instead of a head presentation) or polyhydramnios (too much fluid). If a cord prolapse happens, there are a number of techniques the midwife is able to use to keep the fetus's head off the cord to stop it cutting off it's own oxygen supply. The midwife must maintain the technique until the woman is in theatre and the baby is being delivered by caesarean section. A woman freebirthing wouldn't be able to use these techniques.
Another risk is that of shoulder dystocia during delivery. From the time the head is delivered, there is only 8 minutes to deliver the fetus. If the shoulders are stuck, and the baby isn't delivered within 8 minutes, the baby is likely to have a poor outcome due to there not being enough oxygen getting to the brain. Again, midwives have the knowledge to deal with this, but women freebirthing will not be able to use some of the techniques.
A risk to the mother is that of postpartum haemorrhage (PPH). Some blood at delivery is normal, but until the placenta is out, there is a risk of bleeding. There is a risk after this, too, but whilst the placenta is in, the risk is greatest as the uterus is unable to fully contract. Breastfeeding can help to cause uterine contractions which may speed up the delivery of the placenta. If the woman starts to haemorrhage, large volumes of blood can be lost in a very short space of time. Midwives have drugs which can reduce the bleeding, and are skilled in the techniques used to cope with haemorrhaging. There are a number of risk factors which can increase the likelihood of a PPH, and these include an overly stretched uterus (such as having a multiple pregnancy (twins or more) or polyhydramnios), a fast labour (less than 3 hours) or a slow labour. Women who are 'grand-multips' (having baby number 5 or greater) are also at increased risk.
A number of the articles I looked at seem to confuse freebirthing with home birth. For instance, this articles by the Daily Mail discusses the safety of freebirthing by looking at the statistics and findings of the Birthplace Study. Yes, giving birth at home is safe, and in most cases is safer than giving birth in a consultant led labour ward. But, this study looks at women who are low risk and who give birth at home (or in a midwife led unit or a consultant unit) with midwives. Even if there are no adverse outcomes, these women and their fetus are still monitored and many of the women would still have opted for an active third stage (an injection to deliver the placenta). Using this study to advocate the safety of freebirthing is wrong.
This article by the Guardian discusses a woman stating that she knew she could do it because she had seen a cat give birth. Humans have very different anatomies to cats (the cat's anatomy is shown to the left, with a straight birth canal) - to most other animals, even. The human pelvis has had to adapt to our ability stand upright. This means that, unlike almost every other animal (and I said almost every other animal as I am not an animal specialist - I assume it is in fact every single animal except us humans), humans do not have a straight birth canal. We have a feature called the curve of carus - this is caused by the S shape of our spine, and the lower part of our spine (the sacrum) intruding in to our pelvic cavity. This means that the fetus has to navigate a bit of a bend, between the sacral verterbraes and the rest of the pelvis in order to be delivered safely. This diagram shows a fetus passing through the curve of carus as it descends through the birth canal. The dimensions are already a snug fit, and a fetus who's head doesn't go in the normal way may not be able to pass through this structure very easily. This may cause a longer labour, increasing the risk of a PPH, or causing fetal distress, causing the fetus to pass meconium (stick poo), and this may be aspirated (breathed in to the lungs) and cause breathing problems in the newborn.
In the UK, it is illegal for anyone other than a midwife or doctor to deliver a baby, except in an emergency situation. Doulas should not be present at a freebirth. It is not, however, illegal for women to choose to freebirth.
I have been reading several articles online about freebirthing, and in many have found misused quotes or statistics from sources. Not surprisingly, many of these articles have been written by women who have previously freebirthed.
Whilst these freebirths often happen without a problem, there are a number of risks associated with childbirth which need dealing with almost immediately otherwise there is a risk to the life of mother or baby. A risk during labour is that of cord prolapse. There are a number of factors which cause this to be a risk, and these are anything which prevents the presenting part of the fetus (hopefully the head) descending in to the pelvis before the waters break. These may include an ill-fitting presenting part, such as small fetus, a malpresentation (such as a shoulder presentation instead of a head presentation) or polyhydramnios (too much fluid). If a cord prolapse happens, there are a number of techniques the midwife is able to use to keep the fetus's head off the cord to stop it cutting off it's own oxygen supply. The midwife must maintain the technique until the woman is in theatre and the baby is being delivered by caesarean section. A woman freebirthing wouldn't be able to use these techniques.
Another risk is that of shoulder dystocia during delivery. From the time the head is delivered, there is only 8 minutes to deliver the fetus. If the shoulders are stuck, and the baby isn't delivered within 8 minutes, the baby is likely to have a poor outcome due to there not being enough oxygen getting to the brain. Again, midwives have the knowledge to deal with this, but women freebirthing will not be able to use some of the techniques.
A risk to the mother is that of postpartum haemorrhage (PPH). Some blood at delivery is normal, but until the placenta is out, there is a risk of bleeding. There is a risk after this, too, but whilst the placenta is in, the risk is greatest as the uterus is unable to fully contract. Breastfeeding can help to cause uterine contractions which may speed up the delivery of the placenta. If the woman starts to haemorrhage, large volumes of blood can be lost in a very short space of time. Midwives have drugs which can reduce the bleeding, and are skilled in the techniques used to cope with haemorrhaging. There are a number of risk factors which can increase the likelihood of a PPH, and these include an overly stretched uterus (such as having a multiple pregnancy (twins or more) or polyhydramnios), a fast labour (less than 3 hours) or a slow labour. Women who are 'grand-multips' (having baby number 5 or greater) are also at increased risk.
A number of the articles I looked at seem to confuse freebirthing with home birth. For instance, this articles by the Daily Mail discusses the safety of freebirthing by looking at the statistics and findings of the Birthplace Study. Yes, giving birth at home is safe, and in most cases is safer than giving birth in a consultant led labour ward. But, this study looks at women who are low risk and who give birth at home (or in a midwife led unit or a consultant unit) with midwives. Even if there are no adverse outcomes, these women and their fetus are still monitored and many of the women would still have opted for an active third stage (an injection to deliver the placenta). Using this study to advocate the safety of freebirthing is wrong.
This article by the Guardian discusses a woman stating that she knew she could do it because she had seen a cat give birth. Humans have very different anatomies to cats (the cat's anatomy is shown to the left, with a straight birth canal) - to most other animals, even. The human pelvis has had to adapt to our ability stand upright. This means that, unlike almost every other animal (and I said almost every other animal as I am not an animal specialist - I assume it is in fact every single animal except us humans), humans do not have a straight birth canal. We have a feature called the curve of carus - this is caused by the S shape of our spine, and the lower part of our spine (the sacrum) intruding in to our pelvic cavity. This means that the fetus has to navigate a bit of a bend, between the sacral verterbraes and the rest of the pelvis in order to be delivered safely. This diagram shows a fetus passing through the curve of carus as it descends through the birth canal. The dimensions are already a snug fit, and a fetus who's head doesn't go in the normal way may not be able to pass through this structure very easily. This may cause a longer labour, increasing the risk of a PPH, or causing fetal distress, causing the fetus to pass meconium (stick poo), and this may be aspirated (breathed in to the lungs) and cause breathing problems in the newborn.
Sunday, 15 June 2014
Vitamin K
Antenatally, midwives should discuss the issue of Vitamin K with women. Whilst in labour, or immediately postnatally, it will also be discussed. Women, or the baby's father (if they are married - he then has parental rights and is able to consent) must give fully informed consent before it is given (however, in an emergency, such as admission to the Neonatal Unit/Special Care Baby Unit, it will be given without consent). Those with parental rights may also withhold consent to give Vitamin K.
Vitamin K is essential in order for blood to be able to clot. Low levels of Vitamin K increase the risk of bleeding. This is known as either Vitamin K Deficiency Bleeding or Haemorrhagic Disease of the Newborn. This bleeding can be fatal, and the most common site is within the brain. However, the incidence is low, affecting about 1 in 500 babies, with those who are pre-term at the greatest risk. It can occur up until twelve weeks of age, with the greatest incidence being between two and seven days of age.
Research in to Vitamin K is old and the women researched didn't have easy access to Vitamin K-rich food, such as dark green leafy veg, meaning that the research might not be relevant today.
It is believed that the baby is unable to produce Vitamin K until about six weeks of age, and that it doesn't cross the placenta well. The levels found in breast milk are low; however, colostrum and early hind milk contain the greatest quantities.
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Parents who consent to Vitamin K must choose the route. If given by injection, only one dose is given. However, if given by mouth, multiple doses are required. However, this is not based on research. In fact, research concludes that oral Vitamin K is as effective as that given by injection, and that blood levels of Vitamin K were just as high after one dose of either route.
The final aspect for women to consider when consenting or not to Vitamin K is its production. Vitamin K is made using extracts from cow's gall bladders. This is often not discussed by midwives; in fact, it is often not known by health care professionals. There used to be an alternative; this was taken off the market a number of years ago.
Vitamin K is essential in order for blood to be able to clot. Low levels of Vitamin K increase the risk of bleeding. This is known as either Vitamin K Deficiency Bleeding or Haemorrhagic Disease of the Newborn. This bleeding can be fatal, and the most common site is within the brain. However, the incidence is low, affecting about 1 in 500 babies, with those who are pre-term at the greatest risk. It can occur up until twelve weeks of age, with the greatest incidence being between two and seven days of age.
Research in to Vitamin K is old and the women researched didn't have easy access to Vitamin K-rich food, such as dark green leafy veg, meaning that the research might not be relevant today.It is believed that the baby is unable to produce Vitamin K until about six weeks of age, and that it doesn't cross the placenta well. The levels found in breast milk are low; however, colostrum and early hind milk contain the greatest quantities.
Parents who consent to Vitamin K must choose the route. If given by injection, only one dose is given. However, if given by mouth, multiple doses are required. However, this is not based on research. In fact, research concludes that oral Vitamin K is as effective as that given by injection, and that blood levels of Vitamin K were just as high after one dose of either route.The final aspect for women to consider when consenting or not to Vitamin K is its production. Vitamin K is made using extracts from cow's gall bladders. This is often not discussed by midwives; in fact, it is often not known by health care professionals. There used to be an alternative; this was taken off the market a number of years ago.
Birth Plans - What to Consider
Labour is unpredictable. Women who have never had a vaginal delivery before may not to know what to expect. Women who have had previously had a vaginal delivery might expect a replica of their previous labour. The truth is; labour is unpredictable. Each woman experiences labour differently and each baby's birth is unique.
That being said, women are often quite keen to come up with a birth plan. In my NHS Trust, there is a space in the handheld records for women to write their thoughts on their labour. It is quite vague, but prompts women to consider some of the things that they will have some control over. Here is a look at some of the things in labour which women might like to think about beforehand.
Who will be there?
Women will no doubt have planned whom they will have as a birth partner. Quite often, this will be their partner who is generally the baby's father. But some times, this will not be the case, whether for cultural/religious reasons, or because there is no father or for any other list of reasons. It is important that the woman choose someone who is going to be there to support her, not just someone who wants to be there so they are the first to see the new baby. Women should also consider who will go with her if she were to go to theatre. It will only normally be one of her birthing partners.
In addition to the birth partner, women may also wish to consider if they will have a student present. This will usually be a student midwife, but could be a student nurse or a medical student. And although I have never seen it, I presume it could also be a paramedic student, as paramedics sometimes end up delivering babies. Some women I have spoken to are under the impression that if they give consent for students to be present, there will be a long line of them at the end of the bed, just staring. This is not the case. There will only be one student present (although a medical student did come in for the actual delivery of one of the deliveries I did; she met the woman beforehand, and she was happy for this). Quite often, the student will only have one woman in labour, whereas the midwife may have more than one. This means that the woman will receive constant emotional support from the student whilst the midwife may have to pop in and out to look after more than one woman. The student may or may not be hands on with the delivery. A brand new student may just be there to observe and will do very little else other than chat to the woman and her birth partners, whereas a more senior student may provide most of the care, under supervision of the midwife. Regardless, though, the midwife and the student will seek consent before each procedure, such as vaginal examinations. Even if the woman consents to a student being present, she can decline for the student to also examine her.
Where will the birth take place?
There is no reason why a first time mother cannot give birth at home. A recent study (called the Birth Place Study) has found that low risk women who have babies at home are at a lower risk of a negative outcome, with the exception of first time mums, who have a slightly increased risk, although this is not statistically significant.
At home, women often feel more relaxed and as a consequence, there is better release of the hormone oxycontin - this is the hormone that causes the contractions. There is less risk of interventions and the woman can guarantee that the midwife will only have one woman to look after. There will also be a second midwife called for the actual delivery.
Women planning a home birth or a delivery in a birthing unit or midwife led unit, however, must be aware that there are certain times when transfer to hospital will be advised. Women should be prepared for this outcome, and should listen to t he advice of the midwife.
Will the baby be placed skin to skin?
Skin to skin, where the baby is placed, unwrapped, next to the woman's skin is great for bonding. It helps initiate breastfeeding for those women who are planning to do so, and helps the new born baby control their breathing, oxygen levels, temperature and heart rate. It is recommended that the mum and baby should be left like this, undisturbed, for up to an hour. However, some women do not like the idea of this, as the baby may be covered in some blood, vernix and liquor, and prefer for the baby to be dried down and wrapped up before being given to the woman.
How will the placenta be delivered?
Women can either chose to have an active or a physiological third stage of labour. The third stage of labour is the delivery of the placenta and control of any bleeding. There are two options; firstly, the woman may have an injection of syntometrine or syntocinon. This causes a large contraction and the placenta detaches from the uterus and is delivered with the help of the midwife. The other option is to allow it to happen naturally. The cord is left, attached to the baby an dis not touched by anyone. The woman's body will cause contractions to deliver the placenta. This may take as little as five minutes or as long as an hour. The midwife will observe for any bleeding, and may recommend the injection if there are signs of bleeding.
Will the baby have Vitamin K?
Vitamin K is essential for clotting. Research has shown that some new born babies are deficient in Vitamin K, putting them at risk of bleeding. This is known as Vitamin K Deficiency Bleeding, or Haemorrhagic Disease of the Newborn. Consequently, all parents are asked if they would like their baby to have Vitamin K. This can either be given as an injection shortly after delivery, or by mouth. The injection is given once. The medication by mouth has to be repeated on day 5 and, for breastfed babies, on day 28 also.
The research, however, is old, and was done with women having poor access to Vitamin K rich food. There are no recent research studies in to new borns and Vitamin K.
That being said, women are often quite keen to come up with a birth plan. In my NHS Trust, there is a space in the handheld records for women to write their thoughts on their labour. It is quite vague, but prompts women to consider some of the things that they will have some control over. Here is a look at some of the things in labour which women might like to think about beforehand.
Who will be there?
Women will no doubt have planned whom they will have as a birth partner. Quite often, this will be their partner who is generally the baby's father. But some times, this will not be the case, whether for cultural/religious reasons, or because there is no father or for any other list of reasons. It is important that the woman choose someone who is going to be there to support her, not just someone who wants to be there so they are the first to see the new baby. Women should also consider who will go with her if she were to go to theatre. It will only normally be one of her birthing partners.
In addition to the birth partner, women may also wish to consider if they will have a student present. This will usually be a student midwife, but could be a student nurse or a medical student. And although I have never seen it, I presume it could also be a paramedic student, as paramedics sometimes end up delivering babies. Some women I have spoken to are under the impression that if they give consent for students to be present, there will be a long line of them at the end of the bed, just staring. This is not the case. There will only be one student present (although a medical student did come in for the actual delivery of one of the deliveries I did; she met the woman beforehand, and she was happy for this). Quite often, the student will only have one woman in labour, whereas the midwife may have more than one. This means that the woman will receive constant emotional support from the student whilst the midwife may have to pop in and out to look after more than one woman. The student may or may not be hands on with the delivery. A brand new student may just be there to observe and will do very little else other than chat to the woman and her birth partners, whereas a more senior student may provide most of the care, under supervision of the midwife. Regardless, though, the midwife and the student will seek consent before each procedure, such as vaginal examinations. Even if the woman consents to a student being present, she can decline for the student to also examine her.
Where will the birth take place?
There is no reason why a first time mother cannot give birth at home. A recent study (called the Birth Place Study) has found that low risk women who have babies at home are at a lower risk of a negative outcome, with the exception of first time mums, who have a slightly increased risk, although this is not statistically significant.
At home, women often feel more relaxed and as a consequence, there is better release of the hormone oxycontin - this is the hormone that causes the contractions. There is less risk of interventions and the woman can guarantee that the midwife will only have one woman to look after. There will also be a second midwife called for the actual delivery.
Women planning a home birth or a delivery in a birthing unit or midwife led unit, however, must be aware that there are certain times when transfer to hospital will be advised. Women should be prepared for this outcome, and should listen to t he advice of the midwife.
Will the baby be placed skin to skin?
Skin to skin, where the baby is placed, unwrapped, next to the woman's skin is great for bonding. It helps initiate breastfeeding for those women who are planning to do so, and helps the new born baby control their breathing, oxygen levels, temperature and heart rate. It is recommended that the mum and baby should be left like this, undisturbed, for up to an hour. However, some women do not like the idea of this, as the baby may be covered in some blood, vernix and liquor, and prefer for the baby to be dried down and wrapped up before being given to the woman.
How will the placenta be delivered?
Women can either chose to have an active or a physiological third stage of labour. The third stage of labour is the delivery of the placenta and control of any bleeding. There are two options; firstly, the woman may have an injection of syntometrine or syntocinon. This causes a large contraction and the placenta detaches from the uterus and is delivered with the help of the midwife. The other option is to allow it to happen naturally. The cord is left, attached to the baby an dis not touched by anyone. The woman's body will cause contractions to deliver the placenta. This may take as little as five minutes or as long as an hour. The midwife will observe for any bleeding, and may recommend the injection if there are signs of bleeding.
Will the baby have Vitamin K?
Vitamin K is essential for clotting. Research has shown that some new born babies are deficient in Vitamin K, putting them at risk of bleeding. This is known as Vitamin K Deficiency Bleeding, or Haemorrhagic Disease of the Newborn. Consequently, all parents are asked if they would like their baby to have Vitamin K. This can either be given as an injection shortly after delivery, or by mouth. The injection is given once. The medication by mouth has to be repeated on day 5 and, for breastfed babies, on day 28 also.
The research, however, is old, and was done with women having poor access to Vitamin K rich food. There are no recent research studies in to new borns and Vitamin K.
Waiting To Try
I am still patiently waiting to start trying to conceive. I have been waiting years. I was only about 23 when I first started considering it. And since then, things have got in the way constantly. Sometimes, they were things that I did, like going back to uni. There was no way I could have had a baby whilst still studying. It would have been difficult. Now, I'm looking for a proper, contracted post. But the problem is, I absolutely love being a bank nurse at the moment. I love the fact that I am able to plan when I choose to work. I can pick and choose the days I go in. It's great. I think I am going to have to find a job with regular, contracted hours in order that I can get maternity pay. And then, as soon as I can, I'll go back to just being on the bank.
I've really got to up my exercising and healthy eating, too. I want to lose a couple of stone before trying to conceive - I want my body to be in the best place possible for pregnancy, labour and parenthood.
Please share any tips you might have.
I've really got to up my exercising and healthy eating, too. I want to lose a couple of stone before trying to conceive - I want my body to be in the best place possible for pregnancy, labour and parenthood.
Please share any tips you might have.
Friday, 13 June 2014
The Truth About Labour
Labour is a unique experience for every woman and for every one of her births. Some labours are fast, some are slow. Some labours are straight forward. Some labours have complications. It is not always easy to predict who will have a good labour and who will have complications. Indeed, labours seen by professionals as good labours may, to the woman, not seem to have gone well.
Some women should have continuous electronic fetal monitoring (CTG) during labour. This involves wearing a monitor to measure the contractions and a monitor to measure each of the fetal heartbeats. Some women feel that they are not allowed to move off the bed once the CTG is in place. With the exception of a few women, such as women who have a CTG due to having an epidural, providing both the fetal heart and the contractions can be picked up, women can choose whatever position they so wish, including being off the bed. Not all women need a CTG. Low risk birth settings - home and Midwife Led Units - will not have this as an option, and women who need CTG monitoring in labour will be transferred to a consultant unit. Women who do not need CTG monitoring will have the fetal heartbeat listened to by the midwife every fifteen minutes in the first stage and every five minutes in the second stage.
One common misconception about labour is the length. There is either an idea that labour goes on for days, when this is simply not the case. Women, particularly nulliparous (never given birth) women, may experience intermittent contractions for days before labour begins as the cervix prepares for labour. Whilst the woman may feel uncomfortable or in pain, and become tired during this stage of labour, this is not seen as active labour. This is the latent phase of labour where the woman's body has a lot to do, but the best place for her to do this, regardless of the intended place of delivery, is at home. As a consequence, women who present to hospital, or call out their midwife, will often be told they are not in labour and sent home with instructions to drink plenty of fluids, to rest and conserve energy and to have a light diet. Gentle mobilisation or the use of a birthing (gym) ball may help.
Conversely, woman may have opposite and unrealistic expectations for their labour. Television shows and films show babies being born as soon as the membranes (waters) have gone. The woman has a single contraction, and the baby is born. Whilst some women do have very quick labours, for the majority of women, it is somewhat longer than that. On average, primiparous women (those having their first baby) will be in labour for eight hours, with subsequent labours lasting an average of five hours Progress of 2cm in four hours is considered normal. UK national guidelines expect a primiparous women to be in the second stage of labour (cervix is fully dilated and there is a strong, involuntary urge to push) for no more than two hours. Whilst three hours is still normal, if delivery is not imminent after two hours, she should be referred to an obstetrician for delay in second stage. An instrumental delivery (such as a ventousse or forceps) may be performed. Multiparous women (those who have had a baby before) should be referred after one hour, but two hours is still within the normal time frame.
The midwife will see other signs as the woman approaches the second stage of labour. Her anus will also start to visibly dilate, she may develop a purple line running up from her anus, her sounds may change and the sacrum (lower back) may visible protrude more than it normally does. However, if no progress is seen, a vaginal examination (internal) may be recommended. Throughout labour, these will be offered four hourly, or more frequently if needed. Before each of these, the woman will be asked to use the toilet and her abdomen will be palpated. During the second stage of labour, the frequency increases to hourly. If the woman is unable to pass urine at least four hourly, she may be offered an intermittent catheter. The catheter is passed in to the bladder and the bladder is drained of urine. Whilst this may be an unpleasant thought, it is preferable to either a delay in labour or a damaged bladder from the pressure of the baby's head being forced on to it with each contraction.
While pushing, even once the head is visible, it can take a while to deliver the baby. The woman's pelvis has a bend in it; this is known as the curve of carus, so as the woman pushes the baby will move around this bend. As she relaxes, the baby will slip back slightly. With each contraction, more and more of the baby's head will become visible, and it will gradually remain visible for longer between contractions. Eventually, the head will remain visible between the contractions. A similar process occurs as the head is delivering - crowning. A small part of the head will deliver, and then retract slightly. This is when the genitalia will sting. The baby's head will sit there for a while, slowly distending the perineum (the tissue, including the skin, between the vagina and the anus), allowing it to stretch slowly. Eventually the head will be born. With the next contraction, the baby should be born.
To assist with pushing, the midwife may place her fingers in to the vagina and apply pressure to the vagina wall. This enables the woman to direct her pushing in the right direction. The midwife will be able to assess the pushing from there, as some women, who may appear to be pushing, are not pushing in the right direction.
Women often worry if their membranes haven't gone. These are designed to cushion baby during the contractions, and it is normal for them to break only when the woman is approaching the second stage of labour. Whilst it seems to be something which is offered frequently, or requested by the woman, it is not always necessary and may remove the cushioning the baby and placenta receive during contractions. This can increase the risk of fetal distress. However, there are times when breaking the waters (or preforming an ARM - Artifical Rupture of Membranes) is indicated, such as for induction, augmentation or to improve fetal assessment.
Labour is a messy business. Yes, some women do have their bowels open, particularly during the second stage of labour. This is normal, and is forced out as the baby's head passes through the pelvis. There will also be liquor (waters), blood (up to 500ml, about a pint, is the upper limit of normal) and the baby may have its bowels open as it is born, and a new born babies faeces is black and tarry. The baby may be covered in a white, waxy substance called vernix, and this may be present in the waters, too. A baby born slightly early may be covered in fine, downy hair (which it will soon lose). This is called laguna.
Once the baby is born, there is still the third stage to complete. This involves delivery of the placenta and control of the bleeding. The placenta may be delivered physiologically. This allows the placenta to deliver as nature intended it to, and may take up to an hour, usually much less, to deliver. The placenta is delivered by maternal effort: the woman has to push it out. It is easier to deliver than the baby. Activities such as sitting on a bed pan or toilet may help. Alternatively, the woman may be given an injection to deliver the placenta. This is called an active third stage. Some women will be advised to have an active third stage, such as those women who have had syntocinon (artificial hormones) in labour or women who have had a lot of babies before. Usually, the woman will have a drug called syntometrine, or, if there are any contra-indications to this, such as raised blood pressure, she will be given syntocinon. These drugs cause the uterus to have a contraction, which shears the placenta away from the uterine wall. The midwife will then apply pressure to the umbilical cord, called traction, and deliver the placenta. Sometimes, maternal effort is required to push out the placenta. Sometimes, the placenta doesn't deliver on its own and a manual removal is required.
Whilst there are a number of emergencies that may arise during labour, midwives and obstetricians are trained to deal with these. They are not that common, and they are often relieved by the initial, simpler and less invasive steps. However, despite all the unpleasant sides of labour, the end goal is a healthy baby and a new little family.
National Guidelines:
http://www.nice.org.uk/nicemedia/live/11837/36280/36280.pdf
Some women should have continuous electronic fetal monitoring (CTG) during labour. This involves wearing a monitor to measure the contractions and a monitor to measure each of the fetal heartbeats. Some women feel that they are not allowed to move off the bed once the CTG is in place. With the exception of a few women, such as women who have a CTG due to having an epidural, providing both the fetal heart and the contractions can be picked up, women can choose whatever position they so wish, including being off the bed. Not all women need a CTG. Low risk birth settings - home and Midwife Led Units - will not have this as an option, and women who need CTG monitoring in labour will be transferred to a consultant unit. Women who do not need CTG monitoring will have the fetal heartbeat listened to by the midwife every fifteen minutes in the first stage and every five minutes in the second stage.
One common misconception about labour is the length. There is either an idea that labour goes on for days, when this is simply not the case. Women, particularly nulliparous (never given birth) women, may experience intermittent contractions for days before labour begins as the cervix prepares for labour. Whilst the woman may feel uncomfortable or in pain, and become tired during this stage of labour, this is not seen as active labour. This is the latent phase of labour where the woman's body has a lot to do, but the best place for her to do this, regardless of the intended place of delivery, is at home. As a consequence, women who present to hospital, or call out their midwife, will often be told they are not in labour and sent home with instructions to drink plenty of fluids, to rest and conserve energy and to have a light diet. Gentle mobilisation or the use of a birthing (gym) ball may help.
Conversely, woman may have opposite and unrealistic expectations for their labour. Television shows and films show babies being born as soon as the membranes (waters) have gone. The woman has a single contraction, and the baby is born. Whilst some women do have very quick labours, for the majority of women, it is somewhat longer than that. On average, primiparous women (those having their first baby) will be in labour for eight hours, with subsequent labours lasting an average of five hours Progress of 2cm in four hours is considered normal. UK national guidelines expect a primiparous women to be in the second stage of labour (cervix is fully dilated and there is a strong, involuntary urge to push) for no more than two hours. Whilst three hours is still normal, if delivery is not imminent after two hours, she should be referred to an obstetrician for delay in second stage. An instrumental delivery (such as a ventousse or forceps) may be performed. Multiparous women (those who have had a baby before) should be referred after one hour, but two hours is still within the normal time frame.
The midwife will see other signs as the woman approaches the second stage of labour. Her anus will also start to visibly dilate, she may develop a purple line running up from her anus, her sounds may change and the sacrum (lower back) may visible protrude more than it normally does. However, if no progress is seen, a vaginal examination (internal) may be recommended. Throughout labour, these will be offered four hourly, or more frequently if needed. Before each of these, the woman will be asked to use the toilet and her abdomen will be palpated. During the second stage of labour, the frequency increases to hourly. If the woman is unable to pass urine at least four hourly, she may be offered an intermittent catheter. The catheter is passed in to the bladder and the bladder is drained of urine. Whilst this may be an unpleasant thought, it is preferable to either a delay in labour or a damaged bladder from the pressure of the baby's head being forced on to it with each contraction.
While pushing, even once the head is visible, it can take a while to deliver the baby. The woman's pelvis has a bend in it; this is known as the curve of carus, so as the woman pushes the baby will move around this bend. As she relaxes, the baby will slip back slightly. With each contraction, more and more of the baby's head will become visible, and it will gradually remain visible for longer between contractions. Eventually, the head will remain visible between the contractions. A similar process occurs as the head is delivering - crowning. A small part of the head will deliver, and then retract slightly. This is when the genitalia will sting. The baby's head will sit there for a while, slowly distending the perineum (the tissue, including the skin, between the vagina and the anus), allowing it to stretch slowly. Eventually the head will be born. With the next contraction, the baby should be born.
To assist with pushing, the midwife may place her fingers in to the vagina and apply pressure to the vagina wall. This enables the woman to direct her pushing in the right direction. The midwife will be able to assess the pushing from there, as some women, who may appear to be pushing, are not pushing in the right direction.
Women often worry if their membranes haven't gone. These are designed to cushion baby during the contractions, and it is normal for them to break only when the woman is approaching the second stage of labour. Whilst it seems to be something which is offered frequently, or requested by the woman, it is not always necessary and may remove the cushioning the baby and placenta receive during contractions. This can increase the risk of fetal distress. However, there are times when breaking the waters (or preforming an ARM - Artifical Rupture of Membranes) is indicated, such as for induction, augmentation or to improve fetal assessment.
Labour is a messy business. Yes, some women do have their bowels open, particularly during the second stage of labour. This is normal, and is forced out as the baby's head passes through the pelvis. There will also be liquor (waters), blood (up to 500ml, about a pint, is the upper limit of normal) and the baby may have its bowels open as it is born, and a new born babies faeces is black and tarry. The baby may be covered in a white, waxy substance called vernix, and this may be present in the waters, too. A baby born slightly early may be covered in fine, downy hair (which it will soon lose). This is called laguna.
Once the baby is born, there is still the third stage to complete. This involves delivery of the placenta and control of the bleeding. The placenta may be delivered physiologically. This allows the placenta to deliver as nature intended it to, and may take up to an hour, usually much less, to deliver. The placenta is delivered by maternal effort: the woman has to push it out. It is easier to deliver than the baby. Activities such as sitting on a bed pan or toilet may help. Alternatively, the woman may be given an injection to deliver the placenta. This is called an active third stage. Some women will be advised to have an active third stage, such as those women who have had syntocinon (artificial hormones) in labour or women who have had a lot of babies before. Usually, the woman will have a drug called syntometrine, or, if there are any contra-indications to this, such as raised blood pressure, she will be given syntocinon. These drugs cause the uterus to have a contraction, which shears the placenta away from the uterine wall. The midwife will then apply pressure to the umbilical cord, called traction, and deliver the placenta. Sometimes, maternal effort is required to push out the placenta. Sometimes, the placenta doesn't deliver on its own and a manual removal is required.
Whilst there are a number of emergencies that may arise during labour, midwives and obstetricians are trained to deal with these. They are not that common, and they are often relieved by the initial, simpler and less invasive steps. However, despite all the unpleasant sides of labour, the end goal is a healthy baby and a new little family.
National Guidelines:
http://www.nice.org.uk/nicemedia/live/11837/36280/36280.pdf
Thursday, 12 June 2014
Thoughts on a Miscarriage
When I was 19, I discovered I was pregnant. It was far from ideal. I was young and I was a penniless student. The father of the baby was someone I had fancied for a very long time, but he was not a good man. He was a liar and a cheat. He and his girlfriend were in an on/off relationship, and he frequently cheated on her. He cheated on her with me. Whilst I fancied him, at that time, I suddenly realised he could not be the father of my baby - he was nowhere near ready emotionally. In all honesty, I did not want to be a mum. Whilst I had always been against abortion, I did seriously consider it as an option. Fortunately, the decision was taken out of my hands.
One morning, about three days later whilst visiting a home for homeless young mothers, I started bleeding. I bled on to the chair I was sitting on and the manager of the home pointed it out to me. I was so embarrassed. I cleaned myself up, got in my car and drove home. I retreated to my bedroom for the next couple of days. I bled heavily, passed large clots and had the worst cramps I had ever experienced. I phoned my mentor and told her I wouldn't be in. I said I had come down with a terrible cold.
After about two days, I began to feel better. The bleeding, whilst still heavy, was settling down and the cramps were improving. I don't know what my mum thought: I had told her I had a terrible cold, but she could see I wasn't like I normally am with a cold. She has never asked me about it. I saw the man that evening when I went out. I just acted like normal around him. I felt only relief that I was not still carrying his baby.
I returned to placement that Monday, just five days after the bleeding started. I was a student nurse at the time and was out with the health visitor. I was surrounded by babies and young children, and yet this didn't bother me. In fact, the only thing which I was concerned about was bleeding and leaving a mark on someone's couch.
A year later, I had a placement on a gynaecological ward. I struggled to understand how people were so emotional when they miscarried. For me, at that time, the miscarriage was a blessing. And yet, there I was trying to support women who were going through a miscarriage or a threatened miscarriage. I struggled to understand their grief. The only thing which hit me was the fact that I never sought help of any kind when I was miscarrying; in fact, no one knew I was pregnant. And yet, there were a number of women who had been admitted for an evacuation of retained products of conception ( a D&C, as it is more commonly known) due to the risk of leaving the products within the uterus. I had even used tampons to control the blood loss! I realised how dangerous that was during this placement.
About a year after my placement, I thought I was pregnant again. Whilst that pregnancy would not have been planned, and again, I would have been single, I had almost finished university and was more emotionally ready to handle a pregnancy and becoming a mother. I felt guilty about the fact I never mourned the first pregnancy, and felt repulsed at my callousness regarding it. A pregnancy test, however, quickly ruled out that I was not pregnant.
To this day, no one knows of that pregnancy. But whenever I think about it, I felt guilt and sadness at the fact that the pregnancy, which was unwanted, turned out in such an awful way. Even now, that miscarriage brings tears to my eyes.
One morning, about three days later whilst visiting a home for homeless young mothers, I started bleeding. I bled on to the chair I was sitting on and the manager of the home pointed it out to me. I was so embarrassed. I cleaned myself up, got in my car and drove home. I retreated to my bedroom for the next couple of days. I bled heavily, passed large clots and had the worst cramps I had ever experienced. I phoned my mentor and told her I wouldn't be in. I said I had come down with a terrible cold.
After about two days, I began to feel better. The bleeding, whilst still heavy, was settling down and the cramps were improving. I don't know what my mum thought: I had told her I had a terrible cold, but she could see I wasn't like I normally am with a cold. She has never asked me about it. I saw the man that evening when I went out. I just acted like normal around him. I felt only relief that I was not still carrying his baby.
I returned to placement that Monday, just five days after the bleeding started. I was a student nurse at the time and was out with the health visitor. I was surrounded by babies and young children, and yet this didn't bother me. In fact, the only thing which I was concerned about was bleeding and leaving a mark on someone's couch.
A year later, I had a placement on a gynaecological ward. I struggled to understand how people were so emotional when they miscarried. For me, at that time, the miscarriage was a blessing. And yet, there I was trying to support women who were going through a miscarriage or a threatened miscarriage. I struggled to understand their grief. The only thing which hit me was the fact that I never sought help of any kind when I was miscarrying; in fact, no one knew I was pregnant. And yet, there were a number of women who had been admitted for an evacuation of retained products of conception ( a D&C, as it is more commonly known) due to the risk of leaving the products within the uterus. I had even used tampons to control the blood loss! I realised how dangerous that was during this placement.
About a year after my placement, I thought I was pregnant again. Whilst that pregnancy would not have been planned, and again, I would have been single, I had almost finished university and was more emotionally ready to handle a pregnancy and becoming a mother. I felt guilty about the fact I never mourned the first pregnancy, and felt repulsed at my callousness regarding it. A pregnancy test, however, quickly ruled out that I was not pregnant.
To this day, no one knows of that pregnancy. But whenever I think about it, I felt guilt and sadness at the fact that the pregnancy, which was unwanted, turned out in such an awful way. Even now, that miscarriage brings tears to my eyes.
Monday, 9 June 2014
Shopaholic
I received an email from Amazon the other night, and am very excited to announce that the new book in the Shopaholic series by Sophie Kinsella is due to be released 25th September 2014. I can't wait to read the next instalment of Becky's life, this time set in LA. Shopaholic to the Stars follows Becky, Luke and their daughter Minnie to LA, where Luke is managing the career of a famous actress. Becky wants to become her personal stylist, but Becky ends up working for the actress's rival.I cannot wait until 25th September to get my hands on this book!
Saturday, 31 May 2014
Cooking
I absolutely love cooking. It is one of my passions. I am self-taught and enjoy developing my own recipes. I relish the opportunity to cook for family and friends and enjoy the demands of making a three-course meal for a gathering. I love the challenge of having everything cooked to perfection, served up beautifully and meeting the dietary needs of my guests. I take pleasure in seeing my guests enjoy the food I serve.
So here is my guide to creating the perfect meal for you and your friends and family to enjoy.
Firstly, know your guests. This may seem obvious, but you need to know if someone has any food allergies or doesn't eat specific foods. Likewise, at the most recent family gathering I had, I had to amend my menu upon discovering my cousin was pregnant - the homemade mousse with raw egg was a no go. You also need to ensure the food you serve is age appropriate. I have a wonderful recipe for chicken, but it is cooked in a beautiful white wine sauce and would therefore not be acceptable to the children in my family.
Once you know your guests' requirements, you should chose your menu and select the recipes in advance. When cooking for a large group of people, I prefer to serve food I have cooked before. when cooking for myself or when visiting my immediate family, I am more than willing to try out new recipes. However, when I have a houseful of guests, I prefer to serve something I have cooked before. Likewise, don't run your evening restaurant style - there is no need to offer your guests a choice of food. Cook one main dish and your choice of sides. Either chose to serve family style, by passing serving dishes around (this will increase the washing up though!) or serve and let your guests leave what they don't like. At the last family meal, I did offer a choice of spicy curly fries (out of the freezer, I admit), boiled potatoes or mash (whatever boiled potatoes weren't used were available for mashing with butter and milk).
Shop wisely. I like to have the freshest ingredients possible and shop as near to the day as I can. Unless cooking for an evening meal, I prefer to shop the day before as this doesn't leave my stressed and pressed for time.
I do as much preparation as I can the night before. Foods to be served cold can be prepared in advance. Cold puddings or starters are great to prepare the night before. Homemade bread can be started the night before, taking minimal time the following morning to be finished. Sauces which are served cold, such as cranberry or bread sauce, can be prepared in advance and stored in the fridge. I also lay the table in advance, and close off the room overnight - I don't want the dogs getting in there and getting dog hair everywhere or breaking the glasses! If using candles, light them early enough that they are ready for when your first guest arrives. But remember, tea lights only stay alight for about four hours. Don't have an over-powering fragrance. And remember to switch your music on - you will want something fairly quiet for a meal, to enable your guests to chat, too.
Know your recipes. Know how long everything will take to prepare and cook. Soups can often be allowed to simmer on a low heat, stirring occasionally, which means that these can be started earlier, if necessary. Foods which are cooked in the oven, such as tarts or lasagne, allow you to mingle with guests, and can often be kept warm without spoiling if guests are late arriving. Vegetables, such as peas, sweetcorn or spinach, are quick and easy to cook, making them great sides.
Enlist the help of guests if they offer. My kitchen is tiny and at the last family gathering we had twelve in total. There was not enough counter space, so my sister, my cousin and I had a system going whereby someone dished up the main, someone added the vegetables and potato type, and someone ran the plates to the dining room.
Ensure drinks are freely available to your guests. If you are hosting the event on your own, greeting your guests whilst cooking can be difficult enough. You don't want to have to be running back and to worrying that your guests have drinks. Place bottles and jugs either at the table or on a side table and invite your guests to help themselves. Or, allocate a volunteering guest to ensure everyone has drinks.
And if anyone offers to do the washing up - let them!
So here is my guide to creating the perfect meal for you and your friends and family to enjoy.
Firstly, know your guests. This may seem obvious, but you need to know if someone has any food allergies or doesn't eat specific foods. Likewise, at the most recent family gathering I had, I had to amend my menu upon discovering my cousin was pregnant - the homemade mousse with raw egg was a no go. You also need to ensure the food you serve is age appropriate. I have a wonderful recipe for chicken, but it is cooked in a beautiful white wine sauce and would therefore not be acceptable to the children in my family.
Shop wisely. I like to have the freshest ingredients possible and shop as near to the day as I can. Unless cooking for an evening meal, I prefer to shop the day before as this doesn't leave my stressed and pressed for time.
I do as much preparation as I can the night before. Foods to be served cold can be prepared in advance. Cold puddings or starters are great to prepare the night before. Homemade bread can be started the night before, taking minimal time the following morning to be finished. Sauces which are served cold, such as cranberry or bread sauce, can be prepared in advance and stored in the fridge. I also lay the table in advance, and close off the room overnight - I don't want the dogs getting in there and getting dog hair everywhere or breaking the glasses! If using candles, light them early enough that they are ready for when your first guest arrives. But remember, tea lights only stay alight for about four hours. Don't have an over-powering fragrance. And remember to switch your music on - you will want something fairly quiet for a meal, to enable your guests to chat, too.
Know your recipes. Know how long everything will take to prepare and cook. Soups can often be allowed to simmer on a low heat, stirring occasionally, which means that these can be started earlier, if necessary. Foods which are cooked in the oven, such as tarts or lasagne, allow you to mingle with guests, and can often be kept warm without spoiling if guests are late arriving. Vegetables, such as peas, sweetcorn or spinach, are quick and easy to cook, making them great sides.
Enlist the help of guests if they offer. My kitchen is tiny and at the last family gathering we had twelve in total. There was not enough counter space, so my sister, my cousin and I had a system going whereby someone dished up the main, someone added the vegetables and potato type, and someone ran the plates to the dining room.
Ensure drinks are freely available to your guests. If you are hosting the event on your own, greeting your guests whilst cooking can be difficult enough. You don't want to have to be running back and to worrying that your guests have drinks. Place bottles and jugs either at the table or on a side table and invite your guests to help themselves. Or, allocate a volunteering guest to ensure everyone has drinks.
And if anyone offers to do the washing up - let them!
Pregnancy Dos and Don'ts
Pregnancy can be a scary time for many women. The advice changes frequently, and whilst well-meaning, the advice given by women of older generations might not be thought of as current practice today. It is therefore imperative that women know what current guidelines and research recommends they do or do not do throughout pregnancy
Pre-pregnancy
Before a woman becomes pregnant, she should ensure she and her body are well prepared to cope with the changes she will experience over the next nine months. However, over half the babies born in the UK are not planned pregnancies and therefore women may not have prepared their body for the demands of pregnancy. Folic acid is an important B vitamin which can significantly reduce the risk of a woman having a baby with a neural tube defect, such as spina bifida. Ideally, women should start taking 400mcg per day at least twelve weeks before she plans to become pregnant, and until she is twelve weeks pregnant. The neural tube develops very early in pregnancy. Some women (such as diabetics, epileptics who those who have a family history of neural tube defects) may require higher doses of folic acid, which need to be obtained on prescription. Folic acid, at 400mcg, is available over the counter. Women should also ensure that they are as healthy as possible before they become pregnant.
Weight is an important issue, with women at either end of the spectrum at increased risk of pregnancy complications. Whilst this does not mean women who are underweight or who are obese will have these pregnancy complications, it does increase the risk that they will happen. These complications include pre-term labour, intra-uterine growth restriction (a baby which hasn't grown well and is much smaller than it should be - this increases the risk of stillbirth and complications for the baby following delivery), microsomal baby (a baby much larger than it should be), maternal health complications, such as gestation hypertension (raised blood pressure not associated with the other symptoms of pre-eclampsia, pre-eclampsia and gestational hypertension, and stillbirth.
Women should also give up smoking in the pre-conception period. smoking throughout pregnancy increases the risk of intra-uterine growth restriction, pre-term labour and stillbirth.
Pregnancy
No specific additional calories are required until the third trimester, and even then, it is only an additional 200 calories per day which are required. Dietary advice has changed considerably over the last generation. It also varies widely throughout the world, often with advice from the USA different to over here in the UK. This advice is based on UK recommendations. Once encouraged, liver is now something women are advised to avoid due to the high levels of Vitamin A found within it. The quantity of Vitamin A varies widely within liver, and the safe level of Vitamin A consumption during pregnancy has been greatly debated. The safety of consuming liver during pregnancy is, therefore, not known. All other meat should be thoroughly cooked to prevent infection with toxoplasmosis. Pre-packed meat, such as ham, is considered safe to eat in the UK.
Eggs are something pregnant women worry about. In the UK, women should buy eggs which display the Lion mark. To avoid the risk of salmonella, eggs should be well cooked, and homemade products which use raw eggs should be avoided. Factory produced products which contain raw eggs, such as mayonnaise, are pasteurised. If they are pasteurised, they are safe to eat.
Consuming certain cheese can cause an infection called listeriosis, which can be fatal to an unborn baby. Soft cheeses with white rinds and mouldy cheeses should only be eaten if they have been thoroughly cooked. All other cheese are safe to eat. Likewise, pasteurised milk, or boiled unpasteurised cow's milk is safe to consume. Yogurts and ice cream are also safe, including soft ice cream which has been pasteurised.
Certain types of fish are high in mercury, which can be damaging to an unborn baby. Fresh tuna should be limited to two portions per week or a maximum of four medium sized tins of tuna. Shark, marlin and swordfish are also high in mercury and should be avoided. Up to two portions of oily fish (and fresh tuna counts as oily fish) may be eaten per week. Smoked fish, such as smoked salmon, is considered safe to eat, and sushi may be eaten providing it has been frozen. Shellfish should be thoroughly cooked prior to eating.
Unless the woman has an allergy to peanuts, peanuts are safe to eat in pregnancy. Pate of all kinds, including vegetarian pate, should be avoided. Food hygiene is important during pregnancy. Fruit and vegetables should be washed thoroughly, and all soil removed to reduced the risk of toxoplasmosis.
No safe limit for alcohol consumption on pregnancy has been established. Therefore, the current advice is to avoid alcohol completely. One to two units once or twice a week are possibly safe although there is no conclusive research, and it is therefore best to avoid it.
Caffeine may be consumed up to 200mg per day. Whilst coffee provides high sources of caffeine, it is also present in tea, coke and chocolate.
Smoking has been linked to a number of complications of pregnancy, including preterm labour, low birth weight and an increased risk of stillbirth. Women should be offered the option of a referral to smoking cessation services, and, if needed, certain nicotine replacement therapies can be used, and are available on prescription.
Exercise during pregnancy should be encouraged. Women should continue their normal exercise regime as long as they want to and feel comfortable doing so. However, they need to be aware of changes to their body which could affect balance and the risk of injuries. They should not try and reach peak fitness levels during pregnancy. There is some research which suggests that babies of mums who exercise during pregnancy are better able to cope with labour. Pelvic floor exercises should be commenced and continued during pregnancy. The pelvic floor cannot be too tough, and a strong pelvic floor will help with labour and will recover better after labour.
Perineal massage can also be beneficial. This involves using sweet almond oil and gently massing and stretching the perineum (the area between the vagina and anus). This will reduce the risk of tears during labour. It can be quite uncomfortable at first, but many women find it more acceptable than a tear or an episiotomy (cut).
During pregnancy, sex is generally safe, although at the end of pregnancy, it may cause Brakton Hick's (false contractions). However, some women may be advised to avoid sex, including women who have had heavy bleeding during pregnancy and women whose membranes (waters) have gone. Women's sex drive may change during pregnancy, or they might wish to try new positions.
Flying is safe, but may require a doctor or midwife's note in the final trimester. Remember, however, that women are at increased risk of DVTs and PEs (blood clots) when pregnant anyway, and flying, due to the enforced period of reduced mobility, further increases the risk. Women should keep hydrated and mobilise as much as possible. Women should check with the airline before booking a flight, particularly in the third trimester, as different airlines have different rules concerning the latest gestation they will allow women to fly and from what gestation they require a doctor or midwife's note.
Pregnant or newly delivered livestock can carry infections, particularly sheep. These infections include chlamydiosis, Q fever, toxoplasmosis and listeriosis. These all may cause infection in the mother and miscarriage or stillbirth of the baby. Women are therefore advised to avoid lambing, calving or kidding and to not have any contact with aborted lambs. Clothing should be washed separately to normal clothing. A primary infection with toxoplasmosis during pregnancy, or immediately before, can have an impact on the pregnancy and the baby. Cats are one source of toxoplasmosis, and so women are advised to avoid changing cat litter, or should wear gloves when doing so. Women should also wear gloves when gardening during pregnancy due to the risk of the soil having been contaminated with cat faeces. Tests are available for most infections to confirm whether the woman has already been infected. However, these are not routinely offered to women in the UK. Women in high risk groups, such as those who keep sheep, may wish to discuss the possibility of screening early in pregnancy with their midwife.
Whilst pregnancy may appear to come with a long list of dos and don'ts, and it can at first appear a little overwhelming with conflicting advice coming from all directions, women should talk to their midwife or doctor if they have any concerns. There will usually be information available in their handheld records. Advice should be obtained from reputable sources, such as the NHS website to ensure the advice is current, up-to-date and evidence based.
Pre-pregnancy
Before a woman becomes pregnant, she should ensure she and her body are well prepared to cope with the changes she will experience over the next nine months. However, over half the babies born in the UK are not planned pregnancies and therefore women may not have prepared their body for the demands of pregnancy. Folic acid is an important B vitamin which can significantly reduce the risk of a woman having a baby with a neural tube defect, such as spina bifida. Ideally, women should start taking 400mcg per day at least twelve weeks before she plans to become pregnant, and until she is twelve weeks pregnant. The neural tube develops very early in pregnancy. Some women (such as diabetics, epileptics who those who have a family history of neural tube defects) may require higher doses of folic acid, which need to be obtained on prescription. Folic acid, at 400mcg, is available over the counter. Women should also ensure that they are as healthy as possible before they become pregnant.
Weight is an important issue, with women at either end of the spectrum at increased risk of pregnancy complications. Whilst this does not mean women who are underweight or who are obese will have these pregnancy complications, it does increase the risk that they will happen. These complications include pre-term labour, intra-uterine growth restriction (a baby which hasn't grown well and is much smaller than it should be - this increases the risk of stillbirth and complications for the baby following delivery), microsomal baby (a baby much larger than it should be), maternal health complications, such as gestation hypertension (raised blood pressure not associated with the other symptoms of pre-eclampsia, pre-eclampsia and gestational hypertension, and stillbirth.
Women should also give up smoking in the pre-conception period. smoking throughout pregnancy increases the risk of intra-uterine growth restriction, pre-term labour and stillbirth.
Pregnancy
No specific additional calories are required until the third trimester, and even then, it is only an additional 200 calories per day which are required. Dietary advice has changed considerably over the last generation. It also varies widely throughout the world, often with advice from the USA different to over here in the UK. This advice is based on UK recommendations. Once encouraged, liver is now something women are advised to avoid due to the high levels of Vitamin A found within it. The quantity of Vitamin A varies widely within liver, and the safe level of Vitamin A consumption during pregnancy has been greatly debated. The safety of consuming liver during pregnancy is, therefore, not known. All other meat should be thoroughly cooked to prevent infection with toxoplasmosis. Pre-packed meat, such as ham, is considered safe to eat in the UK.
Eggs are something pregnant women worry about. In the UK, women should buy eggs which display the Lion mark. To avoid the risk of salmonella, eggs should be well cooked, and homemade products which use raw eggs should be avoided. Factory produced products which contain raw eggs, such as mayonnaise, are pasteurised. If they are pasteurised, they are safe to eat.
Consuming certain cheese can cause an infection called listeriosis, which can be fatal to an unborn baby. Soft cheeses with white rinds and mouldy cheeses should only be eaten if they have been thoroughly cooked. All other cheese are safe to eat. Likewise, pasteurised milk, or boiled unpasteurised cow's milk is safe to consume. Yogurts and ice cream are also safe, including soft ice cream which has been pasteurised.
Certain types of fish are high in mercury, which can be damaging to an unborn baby. Fresh tuna should be limited to two portions per week or a maximum of four medium sized tins of tuna. Shark, marlin and swordfish are also high in mercury and should be avoided. Up to two portions of oily fish (and fresh tuna counts as oily fish) may be eaten per week. Smoked fish, such as smoked salmon, is considered safe to eat, and sushi may be eaten providing it has been frozen. Shellfish should be thoroughly cooked prior to eating.
Unless the woman has an allergy to peanuts, peanuts are safe to eat in pregnancy. Pate of all kinds, including vegetarian pate, should be avoided. Food hygiene is important during pregnancy. Fruit and vegetables should be washed thoroughly, and all soil removed to reduced the risk of toxoplasmosis.
No safe limit for alcohol consumption on pregnancy has been established. Therefore, the current advice is to avoid alcohol completely. One to two units once or twice a week are possibly safe although there is no conclusive research, and it is therefore best to avoid it.
Caffeine may be consumed up to 200mg per day. Whilst coffee provides high sources of caffeine, it is also present in tea, coke and chocolate.
Smoking has been linked to a number of complications of pregnancy, including preterm labour, low birth weight and an increased risk of stillbirth. Women should be offered the option of a referral to smoking cessation services, and, if needed, certain nicotine replacement therapies can be used, and are available on prescription.
Exercise during pregnancy should be encouraged. Women should continue their normal exercise regime as long as they want to and feel comfortable doing so. However, they need to be aware of changes to their body which could affect balance and the risk of injuries. They should not try and reach peak fitness levels during pregnancy. There is some research which suggests that babies of mums who exercise during pregnancy are better able to cope with labour. Pelvic floor exercises should be commenced and continued during pregnancy. The pelvic floor cannot be too tough, and a strong pelvic floor will help with labour and will recover better after labour.
Perineal massage can also be beneficial. This involves using sweet almond oil and gently massing and stretching the perineum (the area between the vagina and anus). This will reduce the risk of tears during labour. It can be quite uncomfortable at first, but many women find it more acceptable than a tear or an episiotomy (cut).
During pregnancy, sex is generally safe, although at the end of pregnancy, it may cause Brakton Hick's (false contractions). However, some women may be advised to avoid sex, including women who have had heavy bleeding during pregnancy and women whose membranes (waters) have gone. Women's sex drive may change during pregnancy, or they might wish to try new positions.
Flying is safe, but may require a doctor or midwife's note in the final trimester. Remember, however, that women are at increased risk of DVTs and PEs (blood clots) when pregnant anyway, and flying, due to the enforced period of reduced mobility, further increases the risk. Women should keep hydrated and mobilise as much as possible. Women should check with the airline before booking a flight, particularly in the third trimester, as different airlines have different rules concerning the latest gestation they will allow women to fly and from what gestation they require a doctor or midwife's note.
Pregnant or newly delivered livestock can carry infections, particularly sheep. These infections include chlamydiosis, Q fever, toxoplasmosis and listeriosis. These all may cause infection in the mother and miscarriage or stillbirth of the baby. Women are therefore advised to avoid lambing, calving or kidding and to not have any contact with aborted lambs. Clothing should be washed separately to normal clothing. A primary infection with toxoplasmosis during pregnancy, or immediately before, can have an impact on the pregnancy and the baby. Cats are one source of toxoplasmosis, and so women are advised to avoid changing cat litter, or should wear gloves when doing so. Women should also wear gloves when gardening during pregnancy due to the risk of the soil having been contaminated with cat faeces. Tests are available for most infections to confirm whether the woman has already been infected. However, these are not routinely offered to women in the UK. Women in high risk groups, such as those who keep sheep, may wish to discuss the possibility of screening early in pregnancy with their midwife.
Whilst pregnancy may appear to come with a long list of dos and don'ts, and it can at first appear a little overwhelming with conflicting advice coming from all directions, women should talk to their midwife or doctor if they have any concerns. There will usually be information available in their handheld records. Advice should be obtained from reputable sources, such as the NHS website to ensure the advice is current, up-to-date and evidence based.
Book Review - The Two Week Wait
Plot Summary
The Two Week Wait by Sarah Rayner is a novel about two women desperate to become mothers. Following a health scare, Lou wants nothing more than to become a mother. Her girlfriend has other ideas, and so they split up. Lou is unable to afford to pay for treatment herself, and is unwilling to join the NHS waiting list. She therefore contacts an old friend, who is prepared to go through the treatment with her and to be the father of the conceived child. Coincidentally, he already has frozen sperm stored, and therefore they do not have to wait six months to ensure they sperm is free from transmissible diseases.At the same time, Cath is desperate to try IVF. She and her husband have been struggling with infertility for a while. They have now decided to use an egg donor, and are matched with Lou. This means that they also pay for Lou's IVF, thereby allowing her to afford the treatment, but meaning they take half the collected eggs.
Review
I found this book immensely interesting. This may simply be because I can identify with the two women in their need to become a mother. The characters seemed real, and the book discussed the struggles they all go through. Despite the fact that this book is a sequel to Rayner's first book, One Moment, One Day, I had not read the first book (being instead drawn to the title of this book on the shop shelf due to my own personal circumstances) and do not feel as though I was joining the story part way through.
The writing was good, the research had been done and as a consequence, the book was enjoyable. Definitely a book I would recommend.
Wednesday, 28 May 2014
Old TV series
I've been watching a couple of old but good TV series on Youtube lately. The first was a sitcom called Get Some In about national service in the 1950's in the RAF and the second is a drama called Soldier Soldier which is about a regiment of the Britsh Army in the early to mid 1990s. Both are really good and you should definitely look them up on Youtube.
Friday, 23 May 2014
My Last Delivery as a Student Midwife
I delivered my last baby as a student midwife a short while back. I was fortunate enough to also look after mum and baby on the postnatal ward and chat to her about her birth.
She was a second time mum and had had a speedy delivery with her first baby. We were hoping for the same. She was being induced for being overdue. I attempted to break her waters, but was unable to do so. The midwife failed, too, so the Sister came in and did it.
Contractions started slowly after her waters had been broken, and two hours later, she was re-examined with no change, so we started the hormone drip (syntocinon). After a short while, the contractions were really getting started, coming more regularly, more frequently and much stronger. She was soon begging for an epidural and pleading for the drip to be switched off.
The anaesthetist was contacted and asked to see her. By the time he arrived, about 10 minutes later, it felt that she was starting to show signs of second stage (being ready to push). Upon examination, she was fully dilated, so we explained to the mum that she was too late to have her epidural. She really wanted it, though.
Fortunately, the baby soon arrived. I delivered the placenta. There was minimal bleeding, and mum and baby were settled in for their first cuddles and for mum to start breastfeeding.
I found it a beautiful delivery. It was intense for mum, with being so quick, but she wasn't labouring for hours. She and baby were both safe and well, and there were no concerns with the delivery. Mum didn't think so; she felt it had taken a long time and that she didn't receive the pain relief she needed in labour. We chatted about the actual timescale, and went through the birth summary, which showed how long each stage of labour lasted. It was quick indeed, and she could see that afterwards.
Her delivery really taught me the importance of debriefing the woman and how the perception of different people in the room can be very different, and that is something I will carry in to my practise as a qualified midwife.
She was a second time mum and had had a speedy delivery with her first baby. We were hoping for the same. She was being induced for being overdue. I attempted to break her waters, but was unable to do so. The midwife failed, too, so the Sister came in and did it.
Contractions started slowly after her waters had been broken, and two hours later, she was re-examined with no change, so we started the hormone drip (syntocinon). After a short while, the contractions were really getting started, coming more regularly, more frequently and much stronger. She was soon begging for an epidural and pleading for the drip to be switched off.
The anaesthetist was contacted and asked to see her. By the time he arrived, about 10 minutes later, it felt that she was starting to show signs of second stage (being ready to push). Upon examination, she was fully dilated, so we explained to the mum that she was too late to have her epidural. She really wanted it, though.
Fortunately, the baby soon arrived. I delivered the placenta. There was minimal bleeding, and mum and baby were settled in for their first cuddles and for mum to start breastfeeding.
I found it a beautiful delivery. It was intense for mum, with being so quick, but she wasn't labouring for hours. She and baby were both safe and well, and there were no concerns with the delivery. Mum didn't think so; she felt it had taken a long time and that she didn't receive the pain relief she needed in labour. We chatted about the actual timescale, and went through the birth summary, which showed how long each stage of labour lasted. It was quick indeed, and she could see that afterwards.
Her delivery really taught me the importance of debriefing the woman and how the perception of different people in the room can be very different, and that is something I will carry in to my practise as a qualified midwife.
Old Boyfriends
Isn't it weird when you see an ex?
I was taking my grandmother to the polling station yesterday for the MEP elections, and I bumped in to an old ex as we were heading in. We just said hi, and that was it. It was weird seeing him. I knew him years ago, about eleven years ago. We had the most amazing time together, we spent a good few months with each other, all day everyday. I used to go to his house a lot and absolutely loved his family. His mum and I got on great.
We just drifted apart, though. We never argued or anything. I had seen him a few times around town.
I found out recently he was married. That was strange - he really wasn't the marrying kind (though we were about 16, so who was, really?) so it was weird to find out he was married. I suppose, really, it's like anyone from your past - it's difficult to imagine them any other way than they were when you know them.
I was taking my grandmother to the polling station yesterday for the MEP elections, and I bumped in to an old ex as we were heading in. We just said hi, and that was it. It was weird seeing him. I knew him years ago, about eleven years ago. We had the most amazing time together, we spent a good few months with each other, all day everyday. I used to go to his house a lot and absolutely loved his family. His mum and I got on great.
We just drifted apart, though. We never argued or anything. I had seen him a few times around town.
I found out recently he was married. That was strange - he really wasn't the marrying kind (though we were about 16, so who was, really?) so it was weird to find out he was married. I suppose, really, it's like anyone from your past - it's difficult to imagine them any other way than they were when you know them.
Writing
I used to write on a website called Helium. That site is now closing down and not accepting new work. As a consequence, I may publish some of the articles on here that I wrote over there. Some may be relevant, others not so much.
Not Having Children
Not having children can be a lifestyle choice or something you cannot avoid. Some women see it as a good thing, and enjoy the freedom of not having to consider a needy little person who is demanding of their time and is the centre of the parent’s world. Other women would do anything in their power to have a child. They want to focus all their attention on their own baby or their own child. They would quite happily sacrifice their freedom and personal time for a family. But for various reasons, they cannot have that longed-for child.
When I was younger, I most definitely fitted within the first group. I wanted to be a career woman, travel the world and I didn’t particularly want children. If I did, they would go to boarding school and be raised by a nanny. This feeling was so deep within me that when I had a miscarriage as a teenager after having an unplanned pregnancy, I was relieved that the choice to do something was taken out of my hands.
Now, though, almost ten years later, I feel so much guilt about that. I sometimes even cry about it. Now, at the age of twenty seven, I no longer consider myself childfree. I now consider myself childless. I want nothing more than to become a mum. But, I am single and I don’t menstruate regularly. I fear I will never have another opportunity to become a mother. My chance to have a family has been and gone in that one miscarriage.
Seeing a pregnant woman in the street is difficult. I have a hollow, empty feeling in my stomach. My eyes fill with tears and the smile disappears from my face. My breathing quickens as I try to control my emotions. I have to try hard not to cry.
Sometimes easier, and sometimes more difficult is when people you know are having children. A number of my friends and similar-age family are having children. It is lovely to spend time with them and get to be the fun aunt. And I know that these children are loved. But sometimes, when I know that the mum is not in the best place to have a child, it can make it even more difficult. Jealousy, anger and resentment are just some of the emotions experienced.
I feel torn between supporting the mum and needing to protect myself from the hurt of seeing her experience all the things I want to experience. I feel I need time to adjust to this, and to retreat, lick my wounds and not let the mum feel any of my negativity. Sometimes, I just try to avoid it all together. It is easy in the early days, a simple congratulations and asking when it's due seems to do the trick. But as the pregnancy progresses, and the bump becomes more and more obvious, it's not always as easy.
At work, I manage to slip into a professional mode. I spend my working day surrounded by pregnant mums and newborn babies and manage to get through it. And this is how I must deal with those I know.
Despite this, though, I still go home with an empty heart to an empty house and desperately research ways I can become a mum.
Whilst some see the childfree life as a blessing, and are pleased to enjoy the freedom this brings, others view childlessness as a curse and would gladly exchange adult holidays and long, weekend lie-ins for the worry and joy a child can bring. Despite desperately wanting the single life when I was younger, I am now desperate to become a mum, regardless of the stresses that brings. Like many women, I will do everything my power to get there.
Thursday, 10 April 2014
What Actually Happens in Labour?
After my long stint on labour ward for my placement, I have decided to write about what really happens in labour. The media shows unnatural labours. Soaps and movies have women believe labour will entail her waters popping and going everywhere, a pain, a push and a baby. Shows such as One Born Every Minute obviously want to show the most exciting births. But normally, labour is not like that.
Check out the article I have written about what really happens in labour. Let me know what you think!
Check out the article I have written about what really happens in labour. Let me know what you think!
Wednesday, 9 April 2014
What do babies really need?
What should parents really buy for a newborn? In view of a post I wrote a little while back, this is an article I wrote on Helium about what newborns really need. Check it out and let me know what you think
Friday, 4 April 2014
Not Having Children
Not Having Children is an article I have written about how I feel being a childless woman. Sometimes, being childless affects me more than other times. Reading through this article, I was particularly affected at the time.
Let me know what you think about it.
Let me know what you think about it.
Sunday, 2 February 2014
Births
I have witnessed the birth of countless babies over the last year. Despite the fact that I have seen a number of different types of birth, and understand the mechanics of the process, it still amazes me. It amazes me that two tiny little cells can grow to create a baby. It amazes me that a woman instinctively knows what to do during labour. And it amazes me every time I see a baby's head just sitting there, some where between life in utero and life outside, waiting for that one contraction which will propel him or her in to the outside world.
Saturday, 1 February 2014
Cloth Nappies
Visit her website here: www.thenappylady.co.uk
Wednesday, 29 January 2014
More Plans
So, in addition to all the making plans about conceiving, I have also been trying to make plans about the practical side of becoming a mum. This whole process involves a lot of thinking. So, I have tried to come up with a list if everything I might need for when I (finally) become a mum.
1. Pram. I love the Silver Cross Heritage Collection. I would absolutely love the Balmoral (left), I think it is, by far, the most beautiful pram around. However, it doesn't collapse down at all, and I need something which will fold, to some extent, to fit in my car. So, I think I plan on going for the Kensington (right). It seems a little more practical than the Balmoral. It folds down slightly, so should fit in the boot of my (thankfully very spacious) car, and is slightly smaller, yet it is still absolutely beautiful and looks so comfortable for baby. It is also a little bit cheaper than the Balmoral - about £200. I would love it in pink - my absolute favourite colour - they do a beautiful pink and white in both, but I think I would go for navy. If I had a little boy, pink might not be the best option, whilst navy is more unisex and will keep cleaner looking. There are also a few accessories I would buy, such as the rain cover and the sun canopy.(Both photos from the Silver Cross website: http://www.silvercrossbaby.com/Classic-Prams/ )
3. Bedding. This would be another essential for when baby arrives. I love all the cute bedding sets which everywhere sells. But they seem so expensive, especially since they will frequently become soiled by baby. I much prefer flat to fitted sheets - I try and buy flat sheets for myself - it is the nurse within me which means that I must have lovely, crisp and neat hospital corners on my bed. Fitted sheets just do not have the same appearance. However, it seems quite difficult to find some reasonably priced flat sheets for a crib and a pram. So I will just have to continue my search for these. Blankets seem to sell for anything from £8 upwards, depending on whether they are plain or patterned.
6. Bathing. Nothing much is essential here. I will probably get a cheap baby bath, although even that isn't strictly essential. I will need cotton wool, I will just use towels I already have to dry baby. I don't buy in to the fact that babies need their own special little towels.
7. Feeding. I plan on breastfeeding and will need to buy in nothing special for this.
8. Play. Newborn babies see only in black and white for the first few weeks of life, so I will get a selection of black and white hanging toys and a play gym (preferably with black and white toys attached) for the first few weeks, and then move on to the brightly coloured sort.
9. Cot. I will get one for when baby moves in to their own room at at least six months of age. Again, there are some absolutely beautifully crafted cots out there, but there are also cots on the cheaper end of the spectrum. They are as little as £35 at Ikea and £39.99 at kiddiecare.com. Both require mattresses, but these are available at a reasonable cost. There would then be the cost of bedding to go with these.10. Car seat. These seem to vary enormously in price. From what I can see, a lot of it is about the brand. They seem to run from about £20 (for brands which I have never heard of) to over £200. I quite like the Isofix ones, but I don't think my car has Isofix, so it will have to be one of the ones you have to strap in every time. My main criteria for selecting a car seat will be its safety. I want a make with a proven safety record. I also want one which isn't too expensive (if there is one for £100 which is just as safe as one for £200, I will be more inclined to go for the cheaper one), and I would like one with a hood, so baby has some protection from the sun or rain.
I would need some essentials for after baby - these would include maternity pads and breast pads. It would also help to have lots of things ready for myself after the baby - a well stocked home so that I didn't feel rushed to go out for a while with a new baby if I didn't have to, and a comfortable guest room. I would invite my mum to stay for a short while, just to help me get to grips with everything, and I would want her to feel comfortable.
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