Neighbourhood Midwives

group shot, Kate MB

Originally from the US, I am new to the NHS healthcare system and wanted an extra bit of security knowing I would have continuity in care with certified, experienced midwives.

Neighbourhood Midwives played the most significant role you can imagine in my birth story.  I wasn’t planning on a home birth, but when Leonie came to the house to assess me I had moved through the first stage of labour much more quickly than anticipated and was fully dilated.  Leonie made the call to stay home, and I must say I was relieved. I instinctively knew that things had moved quickly, and I was more comfortable being at home.  Leonie brought in Tess to support, and they were both supported / shadowed by Ellie (a student midwife).

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Michala

So 3 months in to my new job as a caseload midwife (I can’t believe how quickly that’s gone) and I can say without a doubt this is the best decision I have ever made. Not only being a caseload midwife, that was always a given for me after my experience as a student, but also being one in a team whose values are ones that speak to my midwifery soul.

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postnatal guidance at home

Postnatal guidance at home is the care of the woman and her baby during the period from birth to approximately 6 weeks postnatal. It is focused on the health, wellbeing and recovery of the woman and the health, well being and development of the baby. One cannot be considered in isolation to the other and the transition of the woman to a confident, competent mother is an intrinsic part of the process.

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Starting Out As A Caseload Midwife

WELCOME HOME’… They were the words of a friend who understands my need to work in caseload midwifery in response to me sharing that I’d been to my 1st birth with my new team back in September.

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Do we choose birth or does birth choose us?

The process of creating, growing and giving birth to a new human being is a minor miracle for everyone involved. As a private midwife I have had some amazing experiences with  a wide range of birth choices and surprises over the years.

There are many ways of giving birth, some are chosen and some choose us. What is critical is that each woman feels she has played an active part in this process and that her views have been heard and respected. Then she will feel positive about her experience and will not suffer feelings of failure, disappointment or guilt.

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  1. Sleeping while you are pregnant – Why you might not be able to sleep, what’s happening to your body. How to get a good nights sleep, useful tips.

We all know that the first 12 weeks of pregnancy are characterized by a desire to sleep anywhere and anytime. What some women are surprised to discover is that the rest of pregnancy may be plagued by sleep disturbance. Ironic or what?

Let’s talk about sleep. Did you know that a study reported in 2016 found 78% of pregnant women reported some form of sleep disturbance and this was most common in the second and third trimester. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017073/,

The reasons for this are many and varied. You will want to pee more often, you may increasingly find that your changing body shape affects your comfort. Heartburn, leg cramps and nasal congestion can all wake you up. In addition, changes in hormones and possible anxieties may lead to general insomnia. Really makes you want to yawn just to think about it.

Well there are some things you can do to help yourself. Many women report that yoga, mindfulness or similar approaches https://www.be-sophro.co.uk/how-can-besophro-help/how-can-besophro-help-birth-preparation/, really help them to sleep better and avoid the anxieties of sleeplessness. Attention to diet and avoiding caffeine or sugar in the evening can help with heartburn and restless legs while having your bedroom window open a crack can help with nasal congestion as can a nasal rinse or saline drops. Many women find a lavender bath or lavender spray on your pillow helps too. If using it in the bath, make an emulsion with a little milk as this will help the oil to disperse in the water.

You might have also heard about the importance of sleeping on your side and while this is of increasing importance in the third trimester it is worth getting in the habit now. Use pillows of various sizes to support you and help you get comfy. The reason for this advice is that research found a 2.3 fold increase in late stillbirth ie after 28 weeks, in women who regularly slept on their back. https://www.tommys.org/pregnancy-information/sleep-side-pregnancy-campaign

Finally, don’t hesitate to have a daytime snooze. Even 20 minutes can perk you up and give you a boost to enjoy the rest of the day. After all you are growing a new human being.

http://www.neighbourhoodmidwives.org.uk/pregnancy-portal/pregnancy

 

 

  1. Breastfeeding and sleep. What to expect, how to cope with the tiredness.

Whichever method you choose to feed your baby, during the early days you will need to feed him/her every 2-3 hours. Babies have a physiological need to wake frequently to feed and breastfeeding is ideal to support this because it adjusts to suit the baby’s needs and development. In the first few days when his tummy is the size of a cherry, he will need frequent feeds of colostrum which is low in volume and high in nutrients and enhances his immune system. As the milk comes in, the tummy grows quickly to accommodate the larger volume of mature milk with a higher percentage of fat to help baby sleep and grow. However, he still needs 10-12 feeds a day so while you may notice some slightly longer gaps, often in the morning and after the first night feed, at other times he will still feed 2-3 hourly. Added to this is that fact that prolactin, which is a key hormone in the production of milk, is at its highest at night and you can see why it is important to feed through the night. Sorry bad news I know!

So how to cope? The first thing is to really rest during the first couple of weeks when everything is getting established. This means being in bed part of the day and having everything done for you so that you can sleep when your baby sleeps. Sometimes women feel bright and try to carry on as normal but this is not really a great idea since the tiredness invariably catches up with you. Eat and drink really well and try to have someone who will help with nappy changing, providing food and drink for you and help you to settle your baby. This doesn’t mean a nanny or maternity nurse but your partner, mum, mum in law or similar. Most women want the baby near them and enjoy this closeness. The other issue is to be aware that a baby who is feeding well at 7-10 days should not need to be at the breast for hours at a time. All this does is tire you and the baby. So ensure that you get help to latch the baby well and observe what an effective feed looks like. As time goes on you will still benefit from a sleep each day and some couples do a rota at night so the woman gets a few hours uninterrupted sleep at some point. Don’t forget that breastfeeding hormones relax us and help us to sleep.

Finally, learn to sleep lying down and acknowledge that many breastfeeding mums do have a period in the night when the baby might be in bed with them. This is safe as long as you do not drink excessively, smoke, or take drugs.

https://www.lullabytrust.org.uk/safer-sleep-advice/co-sleeping/,

https://www.isisonline.org.uk/where_babies_sleep/parents_bed/,

Treat this time as an extended duvet day!

 

 

  1. Early days – what to expect, typical sleep cycles.

Newborn babies are the most dependent mammals, when they are born they cannot stand to follow their mother, nor cling on to her, so they are totally reliant upon the mother, father or caregiver. The newborn’s brain is primitive and a baby is incapable of any sort of rational thought or conclusion. Fortunately, the baby is born with a powerful, instinctive survival mechanism.  Nature has prepared the baby to seek comfort, care and food as these are essential to his survival. He also needs to feed frequently, every 2-3 hours so you can see why in the early days your sleep will be broken. The interesting aspect to this, is that most women I work with find it is not so much being woken for a feed that is hard to deal with, it is not being able to go back to sleep quickly because the baby will not settle. Why won’t he settle? Because he NEEDS to be close to you for survival. So we have a cycle develop where the parent is desperate for the baby to go back to sleep but s/he cannot because he is in fright mode and needs to be held or close to the parent. The more desperate you become, the more the baby senses it and feels even more anxious, EEK!

This difficulty does tend to improve with time but in the early days you may need to accept that you will spend some time helping your baby to settle after a feed. It is worth reading Sarah Ockwell Smith’s work on this.

So, plan for a 24 hour day with frequent short periods of sleep, rest as much as possible and take all the help that you can.

Once the milk comes in and your baby is feeding well you may notice a longer sleep in the morning (when your milk supply is highest) frequent and patchy feeds in the evening (when your milk supply may need stimulation) and a longer period of sleep at some point in the night. Remember that for a baby, 4-5 hours at night is a long sleep. If you are formula feeding you may notice a similar pattern but generally as baby gets bigger s/he may develop his/ her own pattern.

If it feels overwhelming, take heart that this is a very short period in a baby’s life and you will get through it. Try to share your feelings with your NCT mates and be glad you aren’t back at work.

 

 

  1. Sleep options – Where should my baby sleep?

Moses basket, crib, cot, alongside cot, sleepyhead??? So many choices, but what do each offer?

Perhaps the most important thing to remember is that in the early days, babies struggle to sleep or settle if they are not being held, consequently any sleep option which recreates the feeling of being held or places the baby close to the mum is going to be beneficial.

Department of Health guidance is that babies should be in the same room as the parents for 6 months. During the first few months the baby will be fed frequently, even at night. This means that an alongside cot where the cot acts as an extension to the parents’ bed, is very helpful. Mum doesn’t have to get up to attend to the baby and the nearness means that baby will start to feel secure sooner than in a separate cot. Many of these types of cot are large enough to serve for many months and can be moved away from the bed when it feels appropriate.

The other product that women find really useful is a Sleepyhead, http://www.sleepyheadwebshop.com/en/,

This sleep system, made in Sweden has been popular for a long time and has a massive following. It is flexible and adaptable but the great value is that it helps baby to feel secure and recreates the sense of being held. Consequently, babies sleep easier and for longer. The Sleepyhead can be placed in an alongside cot.

Ultimately, parents choose what works for them but these two approaches have been found to be really helpful.

 

 

  1. SIDDS – What is it, how can it be prevented etc etc.

SIDS is the name given to the unexpected death of a baby, for which there is no obvious, known cause. These usually occur during sleep and can happen wherever babies sleep. No sleep environment is 100% risk-free, however there are well known ways to reduce a baby’s risk of SIDS and most parents are well aware of these:

 

  • Place your baby on its back to sleep, in a safe space with a firm flat mattress, in a room with you
  • Do not smoke in pregnancy or let anyone smoke in the same room as your baby
  • Do not share a bed with your baby if you have been drinking alcohol, taking drugs, are a smoker, or your baby was born prematurely
  • Never sleep with your baby on a sofa or armchair
  • Do not let your baby get too hot or too cold, and keep your baby’s head uncovered

Breastfeed your baby

 

co-sleeping by parents who are smokers, drink alcohol, use drugs, or who have a premature/low birthweight baby is more strongly associated with SIDS than when these factors are not involved. Separate analysis of UK data indicate that sleeping with a baby on a sofa is particularly strongly associated with SIDS.

Those of us who are familiar with breastfeeding will realise that the protective factor of breastfeeding is in conflict with the advice that babies should sleep in their own cot. However, we need to acknowledge that the evidence against co sleeping (in safe circumstances) is not strong and it is safer than falling asleep sitting up in bed or in a chair or sofa.

 

It is very clear from research that many women who do not intend to bed-share, nevertheless actually do so (intentionally) once their baby is a reality. In the most cases both parents are sharing the bed with the baby. In England on any one particular night it is estimated that around 20%-30% of babies share the parental bed at some point during the night-time sleep.

Follow these simple guidelines:

  • Keep your baby away from the pillows.
  • Make sure your baby cannot fall out of bed or become trapped

between the mattress and wall.

  • Make sure the bedclothes cannot cover your baby’s face or head.
  • Don’t leave your baby alone in the bed, as even very young babies can wriggle into a dangerous position.

BEWARE

  • It is not safe to bed-share in the early months if your baby was born very small or preterm.
  • Do not sleep with your baby when you have been drinking any alcohol or taking drugs that may cause drowsiness (legal or illegal).
  • Do not sleep with your baby if you or anyone else is a smoker.
  • Do not put yourself in a position where you could doze off with your baby on a sofa or armchair.

Finally remember that this is a rare occurrence and the Uk has a low incidence of SIDS, only falling behind the Netherlands, Sweden and Japan.

 

 

 

  1. Parenting – Looking at how sleep changes as the child grows. A look at sleep through the different ages. When to change into different beds, what are the option.

 

All  living creatures need to sleep. It is the primary activity of the brain during early development.  

Circadian rhythms or the sleep-wake cycle, are regulated by exposure to natural light and dark and take some time to develop, hence the irregular sleep patternsof newborns.

The rhythms will begin to develop at about six weeks, and by three to six months most infants have a regular sleep-wake cycle.

By the the time your baby is two years old s/he will have spent more time asleep than awake. Sleep is especially important for children as it directly impacts mental and physical development.

As babies reach 6 months many will start to sleep through the night, 70-80 percent may do so by nine months of age but sleep disturbances are still common into the second year of a baby’s life. Sometimes parents try to eliminate daytime naps to encourage longer sleep at night. This rarely works and often leads to overtiredness and poorer sleep.

 

Toddlers need about 11-14 hours of sleep in a 24-hour period and will continue to need daytime naps.

 

Tips For Toddlers:

  • Try to maintain a regular sleep schedule and consistent bedtime routine.
  • Try to ensure that the bedroom environment is comforting and the same every night and throughout the night.
  • Be consistent.

Offer and encourage a special security item such as a blanket or stuffed animal.

Offer reassurance and comfort if your child wakes and is distressed. Meeting his needs will reassure him and help him to resettle.

As vbabies grow out of the moses basket/alongside cots, they will graduatel to a full size cot and eventually a bed. The age at which a child is ready for a bed will vary from child to child. Estimates are from one and a half years to 3 and a half years. Probably leaving it until nearer three will give your child time to adjust and cope.

A word of caution, do not try to do this too close to when a new baby is on the way. That way lies disaster! Also be wary of a bed that is too sophisticated, eg a high bed etc, many children find this too difficult to cope with.

Again, remember that all children eventually get there and in developing countries children continue to sleep with their parents for many years. So relax and take your time.

 

Tina Perridge RM

http://www.neighbourhoodmidwives.org.uk

02088746624

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Neighbourhood Midwives – A brief history of who we are and why we have chosen to work in this way

With the end of 2017 and our first year of providing an NHS midwifery service completed it feels the right time to give some background as to why we chose to set up an independent midwifery organisation, to describe our journey to date and to share our goals for 2018 and beyond.

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