So, as you probably know by now, I am desperate to become a mum. Despite the fact that the desire is always there, sometimes it is more controllable than others. In that respect, this has been a bad week.
I'm currently working in pre-op assessment. We see patients who are having elective general anaesthetics. A number of the patients have cancers of some sort, but usually these are localised and hence they are able to have surgery to remove it. Therefore, unlike on the wards, I don't really feel very much emotional involvement towards my patients.
This week was different, though.
For the first time since I have been working in pre-op, I saw a woman who was coming in for a termination. Now, for years, I have struggles with my beliefs about terminations. I have flipped between pro-life and pro-choice. On one hand, I struggle to understand how women can choose to end the life of an unborn baby just because it does not fit in with her life plan. However, I also don't think it is fair that it is purely the woman who may be left with the consequences of an unplanned pregnancy. On the other hand, friends of mine had a termination when they were pregnant with a baby who would not have survived. Having this baby, carrying him to term and delivering him only to watch him die would not have been fair on this couple or the two other young children they had at home who would have struggled to understand.
Anyway, this woman was having a termination as she didn't want to have another baby (her youngest was a little under a year old). I was almost tempted not to pre-op her (under the NMC (Nursing and Midwifery Council) regulations, we have the ability to conscientiously object to providing care for women having such procedures, except in a life-threatening situation). All the other nurses had patients, this lady had asked the healthcare assistant twice in the few minutes I was reading through her notes (before I discovered what she was coming in for) how long it would be before she was seen by a nurse as she had to leave soon to pick her older children up from school. She had quite complicated medical history, hence why she was coming to hospital for the termination and not to a clinic. I decided I would have to see her.
It was quite a difficult pre-op. She was reluctant to engage in conversation. The baby was screaming. She wouldn't make eye contact. She was on the defensive. I finished my assessment and sent her on her way.
I almost cried when she left my room.
I felt guilty that I had participated in some small way to that termination.
I don't think I will pre-op women in the future who are coming in for a termination. Instead, I will use my right to conscientiously object.
Now, I don't know if I have just been in a rather vulnerable state, or if it is something I have only just noticed, but this evening, driving home from work, I had to switch off the radio. The presenter was, once again, talking about babies and pregnancies. Pretty much every show of his seems to feature a phone-in about either babies or pregnancy, and it's really getting to me. Do they not have any tact and sensitivity for the women who may be listening to the radio station and who are desperately try to conceive a baby?
Thursday, 14 May 2015
Sunday, 10 May 2015
VE Day Anniversary
This weekend has commemorated the 70th anniversary of victory in Europe (VE) at the end of World War 2. Reading the article on the BBC News, it suddenly hit me that these veterans are getting older. These men and women, who fought bravely for Britain, now remind me of when I was a child and would see the veterans of World War 1 at the Cenotaph at Remembrance Day services. And it made me think that we must listen to these men and women and hear their first hand accounts of serving in World War 2.
Whilst there were 1,000 veterans at the service attended by the Queen, and obviously many more throughout the country, their numbers are falling. It is almost six years since Harry Patch, the last British veteran of World War 1, passed away and four years since Frank Buckles, the last known veteran of World War 1 passed away. However, these men were not the norm, with Mr Patch passing away at 111 years of age and Mr Buckles at 110 years of age. along with a small handful of other veterans who passed away at around the same time, these men lived exceptionally long lives; much longer than the UK average of 83 years for men and 79 years for men. This means that these veterans are already on 'borrowed time' and we need to value them whilst they are here.
70 years is a monumental anniversary and we should celebrate it. However, the anniversary has been poorly covered in the media, with more focus on how wrong the general election polls were. Instead, we should have been focussing our efforts on celebrating the end of World War 2 and the service these veterans provided to the country. Without them, we may not have had a general election at all.
So, on a final note, if there are any World War 2 veterans reading this, I would like to say a massive thank you to what you did for this country and the sacrifice you were prepared to make. Thank you!
11/5/15 - edited to add that, whilst Mr Patch was widely publicised as being the last British veteran of World War 1, it appears that this information is not completely accurate. Whilst he may have been the last British survivor to have fought in World War 1, Florence Green, who passed away in 2012 aged 110 years had been a steward in the officer's mess and a member of the Women's Royal Air Force.
Whilst there were 1,000 veterans at the service attended by the Queen, and obviously many more throughout the country, their numbers are falling. It is almost six years since Harry Patch, the last British veteran of World War 1, passed away and four years since Frank Buckles, the last known veteran of World War 1 passed away. However, these men were not the norm, with Mr Patch passing away at 111 years of age and Mr Buckles at 110 years of age. along with a small handful of other veterans who passed away at around the same time, these men lived exceptionally long lives; much longer than the UK average of 83 years for men and 79 years for men. This means that these veterans are already on 'borrowed time' and we need to value them whilst they are here.
70 years is a monumental anniversary and we should celebrate it. However, the anniversary has been poorly covered in the media, with more focus on how wrong the general election polls were. Instead, we should have been focussing our efforts on celebrating the end of World War 2 and the service these veterans provided to the country. Without them, we may not have had a general election at all.
So, on a final note, if there are any World War 2 veterans reading this, I would like to say a massive thank you to what you did for this country and the sacrifice you were prepared to make. Thank you!
11/5/15 - edited to add that, whilst Mr Patch was widely publicised as being the last British veteran of World War 1, it appears that this information is not completely accurate. Whilst he may have been the last British survivor to have fought in World War 1, Florence Green, who passed away in 2012 aged 110 years had been a steward in the officer's mess and a member of the Women's Royal Air Force.
Saturday, 27 September 2014
Periods and Stuff
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.
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, 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.
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