Midwives – The Lowdown

Midwives – The Lowdown, NHS or Independent what are the pro’s and con’s?

Midwives are trained pregnancy and childbirth care professionals, available in the UK through the NHS or independently.

In the UK, midwifery-led care has become the norm, and midwives are generally responsible for the care of all low-risk patients – and some of them care for high-risk patients, too. This has freed up a lot of time for obstetric consultants, who are now reserved for specialist pregnancy and labour care.

But how do you know what kind of midwife to choose? With independent midwifery clinics springing up across the UK, it can be a difficult choice to make. In this article, we will attempt to make this choice a little easier for you.

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Safer baby sleep

This is a guest posting from The Lullaby Trust. The Lullaby Trust, formerly FSID, promotes expert advice on safer baby sleep and provides specialist support for bereaved families.

Working with a baby or toddler can be an exciting and rewarding experience. However, we know how worrying it can be making the best decisions to keep babies and toddlers as safe as possible.

Sudden Infant Death Syndrome (SIDS) is the sudden and unexplained death of a baby where no cause is found. While SIDS is rare, it can still happen and our advice below will ensure that the baby or toddler in your care is sleeping as safely as can be both a night and during the day.

Things you can do when working with a baby:

Always place the baby on their back to sleep

• You should always place the baby on their back to sleep and not on their front or side

• Make sure you and the family you work with are consistent with back sleeping- the chance of SIDS is particularly high for babies who are sometimes placed on their front or side

• Once the baby can roll from back to front and back again, on their own, they can be left to find their own position

Keep the baby smoke free

• Never smoke around the baby or have the baby on contact with smoky skin or clothing.

• Don’t let people smoke near the baby and keep the house, car, and other places the baby spends time, smoke free

Opt for expressed breast milk over formula

• If you have the option, always prioritise breast milk over formula, as this can be protective against the risk of SIDS

Place the baby to sleep in a cot or Moses basket in the same room as you for the first 6 months, even during the day. It’s the safest place.

• The chance of SIDS is lower when babies sleep in the same room as their parents or carers, but do not share the same bed as them

Ensure the baby has a firm, flat, waterproof mattress in a good condition

• You and the baby’s family should avoid using soft or bulky bedding (such as quilts, pillows and duvets) as these increase the chance of SIDS

• Sleep the baby on a firm, flat mattress that is clean and in a good condition. A mattress with a waterproof cover will help you keep it clean and dry

Things to avoid when working with a baby:

Never sleep on a sofa or in an armchair with the baby either next to you or on your chest, even during the day

• Sofa sharing with a baby greatly increases the chance of SIDS

Avoid letting the baby get too hot or too cold

• A room temperature of 16-20⁰C, with light bedding or a lightweight well-fitting sleeping bag, is comfortable and safe for sleeping babies

• Check the baby regularly to see if he or she is too hot. Look for sweating or feel the baby’s tummy – their hands and feet will usually be cooler, that’s normal. If the baby is hot, remove one or more layers of bedclothes.

Don’t cover the baby’s face or head while sleeping or use loose bedding

• The use of loose bedding which can cover the baby’s face or head can be dangerous and can increase the chance of SIDS

• To keep the baby safe and their head uncovered while they are sleeping you should:

o Place your baby on their back in the ‘feet to foot’ position – this is where the baby’s feet are placed at the foot of the cot – so they can’t wriggle down under the blankets

o Use blankets which are firmly tucked in, no higher than the baby’s shoulders or baby sleeping bag

For more information and advice, see the Lullaby Trust’s website at www.lullabytrust.org.uk, or phone the information and advice line on 0808 802 6869.

Happy nannying!

How to Choose Independent Midwives for a Home Birth

Independent midwives are becoming a popular choice among pregnant families. Many mothers feel safest in the hands of midwives who do not have to deal with the problems of understaffing in NHS hospitals, and prefer the more personal approach.

Independent midwives are generally most popular amongst women who want as natural a birth as possible. Childbirth is seen as an important rite of passage by many women, so it’s understandable that they wish to hire midwives whose ideals mesh with their own.

So, how do you go about choosing your midwives? Here are some of the things you would want to consider.

What are their perinatal mortality and morbidity rates?

Perinatal mortality and morbidity are the statistics that you should be concerned with when choosing your midwives. The terms cover death or serious injury in late term pregnancy, during birth and the immediate postpartum period. Of course, some deaths cannot be avoided, but you will want to know whether their statistics are within normal ranges.

What is their transfer rate?

Many people who are hoping for a home birth will look for the midwives with the lowest transfer rate. A low transfer rate is good for those who are seeking a natural home birth, but you should also look at this number in conjunction with their perinatal mortality rates. A low transfer rate coupled with a higher than average perinatal mortality rate is a sign that you should run for the hills.

What are their feelings towards natural birth?

If it is important to you to have a natural birth – and if you’re seeking a home birth, that’s most probably the case – you will want to be in the hands of midwives who believe in natural birth as much as you do. Finding a balance is hard sometimes as midwives are medical professionals first and foremost – their primary concern is your health, and the health of your baby. You cannot expect professional midwives to agree to attend a home birth if the risk of danger to you or the baby is too high. Of course, your eligibility for home birth will depend on many factors such as any previous pregnancy complications, your distance from the hospital and how many children you have had. Again, balance is the key. Try to find midwives who are passionate about, and trust in natural birth and its benefits, without being too dismissive of the fact that sometimes complications occur despite all our hard work in preparing.

What happens if you need to transfer?

You will need to know what happens if you end up having to transfer to hospital. Will your midwives accompany you? And in what capacity will they accompany you? Usually, they will accompany you in the capacity of a doula (a labour and post-partum support person) but you will need to check this before the birth.

What happens if your midwives aren’t available?

Babies rarely come when they are expected to, and sometimes emergencies will crop up that mean your midwives won’t be available to attend your birth. Make sure that they have a contingency plan. Usually there will be many midwives within a private practice, but make sure that there will always be somebody available to come to you.