Induction for Obstetric Fear (aka large for dates)

(July 2018)
The criteria for inducing the onset of labour in pregnancy seems to be widening, with the term ‘high risk’ having an increasingly broad net. However one term which has remained steadfastly clinically contraindicated and yet still widely practised, is ‘induction for large for dates (LFD)’.
NICE guidance is clear on the issue (NICE CG70 July 2008):
1.2.10 Suspected fetal macrosomia1.2.10.1 In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic). So first of all, what is large for dates? Clinically speaking it is a baby born with a birth weight of equal to or more than 4kg. This occurs in 2-10% of births in the UK, however, and this is a significant ‘however’, as the diagnosis of macrosomic babies is notoriously variable in sonographic accuracy with a range of 15% to 79%.

Furthermore a systematic review of RCTs concluded that there was no statistical s…

Exploring Midwives’ Experience of Bereavement Care

(June 2018)
Last year I cared for a woman who experienced a stillbirth at term. As a result I suffered symptoms of PTSD and required counselling in order to move forward. I came to realise that much of my recovery was tied up in the worry that I was not meant to ‘feel’ in this way. The grief belonged to the mother so why did I feel so bereft. Through the help of a skilled counsellor and a huge amount of reflection, then ultimately through writing this article I was able to untangle some of those feelings.

My hope is that in reading this, others will be helped through a recognition that the midwifes grief is a valid, albeit complex process. If this is you, then please do reach out and get the support you need. The article was published as a blog post on my most favourite midwifery journal website The Practising Midwife / All4Maternity, a fantastic comprehensive resource for all birthy types.

I recently discovered that the wonderfully brave and courageous woman I supported last year h…

Breastfeeding support – Missing a trick?

(February 2018)
As a breastfeeding counsellor with experience in facilitating breastfeeding antenatal sessions with over 500 partners of potentially breastfeeding mothers I have shifted my focus over the years from simply helping partners to understand the way feeding works, to helping them to visualise what life will be like as a fully involved parent, enabling their partner to have a positive breastfeeding experience as well as helping their babies to receive the optimum nutrition he or she requires.

Becoming a midwife however has really opened my eyes to the realities of integrating partners in the early neonatal period. There have been improvements in the involvement of partners throughout labour and birth and many NHS Trusts do allow partners to stay for the first night following the birth of their baby in response to mothers saying they want this to happen. However as midwives, what is our expectation of the level of involvement and why do we think they are staying? It is known t…

Hold him please

(July 2017)

I held him for a while
Your pain too great to bear his weight
But still
You wished him held close
and so I did
His body kept warm against my own
and touched his fingers, told you he is beautiful
as you looked at me bleakly

I held him for a while
watching his small face
and rosebud mouth so still
Willing him to move and stir to life
But my will wasn’t strong enough and neither was yours

I held him for a while
felt your eyes on mine
as I looked at his
Held him just long enough to remember his face
now etched in my mind
and still you watched

I held you both for a while
as the emptiness washed over the three of us
And I placed him in your arms
while his warmth lingered
Watched you breathe him in
Sweet fragile boy, too still for life

Paracetamol… Friend or Foe?

(June 2017)
As I slowly began to take more triage calls as a student midwife, I learnt the early standard ‘advice’ we would routinely give to women calling in early labour… “Have you had a bath and a couple of paracetamol?” being the primary line of defence in encouraging women to cope at home, away from the intervention and interference of the labour ward. The intention is of course pure, when everything is normal and if that is where she feels safe, then the best place for a woman to be in early labour is at home.

So what if the very thing that is intended to help women to cope with the latent phase of labour, is actually causing the latent phase to last longer?

I read a fascinating blog post by Midwife Undercover  who had noticed an apparent increase in the length of the latent phase of labour and had consequently looked into the possibility that paracetamol was the culprit. As I read, I felt like I was experiencing an ‘eureka’ moment – paracetamol works by inhibiting prostagland…

The Dreaded Third Degree Tear…

(March 2017)
On supporting a woman in labour who subsequently sustained a third degree tear, and the experience of significant feelings of guilt and hand-wringing, I have been reflecting on my role in the possible prevention of such a degree of trauma and then the support given to women following repair as well as the outlook for morbidity.

According to the Royal College of Obstetricians and Gynaecologists (RCOG), a third degree tear can be defined as “a tear that involves the muscle that controls the anus (the anal sphincter)” and affects on average 3% of women giving birth; broken down this equates to approximately 6% of primiparous women and 2% of multiparous women although the risk increases to 5-7% if they have sustained a previous third degree tear (2015). Clements (2001) takes a more conservative stance, estimating third and fourth degree tears to be more in the region of 1-2%.

Regardless of the percentile incidence, the reality is that the long term implications of suffering …