Denise and her blog
Natural Remedies During Pregnancy
Are we asking women enough questions about their use of natural remedies during pregnancy?
When a woman is admitted to triage or an antenatal ward, we routinely ask about medications. But how often do we ask about herbal remedies, essential oils or other complementary therapies?
From clary sage to raspberry leaf tea and ginger, women may be using natural remedies without realising their potential risks, particularly when used inappropriately or alongside other medication.
As midwives, it's important that we ask these questions without judgement, creating an environment where women feel comfortable sharing what they've been using.
Understanding their use of complementary therapies could provide valuable information when assessing their care.
Impending Grandmotherhood – “Pleased To Petrified” – And The Value Of The Experience For NMC Revalidation
Ninka and Adam are now three quarters of the way through their pregnancy. They have an estimated date of early January but with twins, it’s almost guaranteed they’ll be here before Christmas. At present they’re taking a well-earned pre-babies break on the South African coast, just the two of them, although I am sure the babies will be making their presence felt in one way or another. Not only are they preparing for the imminent births, but they have also recently moved house to accommodate their growing family, so it’s all go.
I have gone through various stages from “pleased to petrified” - well not quite petrified, but I have found it difficult to switch off my midwifery brain and just go with the flow of excitement and expectation. I can obviously give plenty of general advice, but it’s difficult to be objective about any worries Adam and Ninka have, especially when they’re 6000 miles away. Recently, I had to “phone a friend”, one of Expectancy’s Licensed Consultants who is an independent midwife - Amy Gibson, the Sevenoaks Midwife – inviting her for a coffee and telling her I needed a serious “talking to” to balance my emotions. Joking aside, Amy was brilliant – she actually provides antenatal classes for grandparents so is well versed in helping them to prepare for the new additions to the family. She sent me a copy of her booklet for grandparents which, despite being a midwife for almost 50 years, I found interesting and informative.
As a midwifery educator who has spent decades focusing on my specialist subject of complementary therapies and who has not been in NHS clinical practice for a very long time, I realised where some of the gaps in my knowledge are. For example, it was fascinating to realise that some aspects of preparation and helping mothers to breastfeed have changed significantly since I was in clinical practice. Yes, I knew about colostrum harvesting – but I didn’t really appreciate its value as it was never a “thing” when I was in clinical practice. I have since done some reading around the subject that I might not have done.
Similarly, although Adam and Ninka’s twins are dichorionic, diamniotic (DCDA) non-identical twins, their new obstetrician has sown a seed about the possibility of twin-to-twin transfusion syndrome. Despite knowing from the scan that there are two placentae, they now appear to have fused together (or maybe they’ve just taken up space next to each other), so the doctor has mentioned TTTS and, I think, caused more anxiety than was necessary, especially since the incidence of the syndrome is only about 10-15% of monochorionic pregnancies. This caused me to reflect on how obstetricians and midwives often talk of risk without discussing the lack of risk – ie if TTTS only occurs in just 10-15% of monochorionic pregnancies, then it does not develop in the other 85-90% - and does not develop in non-identical pregnancies. Perhaps someone will correct me if I am wrong in this, but nothing I could find suggested otherwise.
I have realised that I am continuing to learn and update my knowledge during this pregnancy and recognised the value to my own midwifery revalidation with the Nursing and Midwifery Council. I hope to count several hours’ worth of practice experience during this pregnancy with, I assume, plenty more to come when I meet the twins. Personal experience can be a valuable addition to learning - I once acted as a confirmer for a midwife who had had two babies in three years and was anxious that she didn’t have enough “practice hours”. I advised her to reflect on what she had learned from her personal experiences of being pregnant and giving birth and we then discussed it at length. Sadly, her experience had not been quite as she wanted but her reflections on her own lack of care enabled her to discover how she might change her own practice when caring for expectant and birthing parents.
Anyway, while Adam and Ninka spend some time together this week, relaxing and planning, there’s a lot going on behind the scenes. Ninka’s mother, a French paediatrician, is travelling to South Africa in mid-November, hopefully in time for the birth. Adam’s father is flying out to spend Christmas and New Year with his South African family, so some of the grandparents will be there in the early weeks. That just leaves me to plan my trip – delayed due to my teaching commitments – but I’ll be there in spirit until I go in the spring for a couple of months.
Has Physiological Birth Had Its Day ?
So …. the solution to the maternity care crisis is, apparently, to consolidate services in mainstream maternity units and to close many stand-alone birth centres and small units. The justification is, allegedly, to reduce Caesarean section rates. However, consolidation of services can only serve to increase rather than reduce intervention. Once a woman is caught up in the obstetric system, the “institutional ticking clock” begins: medical staff and midwives, complicit in a paternalistic, litigation conscious system, want to “do something” to expedite birth, instead of leaving physiology to take its course (which is deemed to be too “dangerous”). Added to this, we can surmise that closing small units and requiring parents to make longer journeys to the main maternity unit is bound to lead to other problems. We only have to look at the closure of North Devon unit to envisage problems of hour-long journeys to Exeter (longer in the tourist season traffic) leading women possibly having to give birth by the side of the road - or worse. Closure of small units also means midwives and medical staff having to travel further to their place of work. This only adds to the length of their already demanding days, leaving them tired, irritable and potentially less able to make sound judgements in iatrogenic situations caused by the very consolidation of services that seek to reduce them.
Whilst I sympathise with those families who have lost babies and even mothers, they are a small proportion of the almost 600,000 annual births in the UK. A stillbirth rate of around 4 per 1000 births remains unacceptable but we need also to look at the other 96 women per 1000 births who delivered live babies. Whilst a proportion of these may have had pathological issues truly warranting intervention, a large number of parents express dissatisfaction with their birthing experiences, even when everything is “normal”. In the rush to reduce mortality by intervening and controlling birth, are we in fact increasing morbidity – particularly psychological morbidity? Indeed, will the number of parents seeking birth trauma resolution rises exponentially with consolidation of maternity services?
And crucially, what will all this mean for physiological birth? We already know that midwives are leaving the NHS in their droves because of burnout and not being able to practise in the way they trained. We see students failing completely to understand how to facilitate physiological birth. This is not their fault, it is the fault of the clinical and education systems in which they are trained. We have managers trying to balance the books and staff the unit with impossible numbers, whilst implementing unrealistic management strategies only intended to benefit the organisation rather than individuals (staff or parents). And we have the clamouring of the media to medicalise birth further. All of this makes me wonder, somewhat cynically, if physiological birth will survive.
I am not about to postulate on what might be the answers to the maternity care crisis: it is far too complex to blame it on one or two causes or to reach solutions from an individual perspective. It is a combination of inadequate funding, national and local mismanagement, increased, more diverse and medically complex service users, national (governmental) priorities and, in my opinion, the general demise of a free-at-the-point-of-access NHS which is no longer fit for purpose. Much of these have contributed to an apparently uncaring, bullying, culture within the maternity services – services which have changed out of all recognition since I began my midwifery career in the 1970s. We seem to have forgotten whom we serve – the public – and I think it is fair to say that the NHS no longer offers a service but is merely a provider, albeit not a very good one.
There is an insidious national (and international) movement to hijack “normal” birth and control it as a medical condition that requires surgical intervention – but at what cost? Are we at risk of changing the human biome because babies fail to acclimatise to an unnatural way of doing what has been done for eons? Will parents choose unassisted birth because of a fear of “the system”, perhaps occasionally when medical care could make the difference between life and death? Will the profession of midwifery be lost, subsumed into the nursing profession and simply become “obstetric nursing”, despite centuries of being a profession in its own right? We are in danger of causing a problem in which the greater the institutional intervention in maternity services, the less appreciation for physiological birth there will be – from midwives, doctors, expectant parents, maternity service managers, budget holders, public media and the government.
Previous articles
Natural Remedies During Pregnancy
Impending Grandmotherhood – “Pleased To Petrified” – And The Value Of The Experience For NMC Revalidation
Has Physiological Birth Had Its Day ?
Aromatherapy In Midwifery: Dangerous Practices That Threaten Forty Years Of My Work.
Driving Forwards - Transition From Student To Midwife
Traditional Medicine Approval
Caesarean Birth Is Not A Lifestyle Choice!
Birth Of My Son
Paternalism in Maternity Care: The “Just In Case Syndrome”
Transitioning Role From Midwife To Grandmother
