Michelle Tant

(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 macrosomia 1.2.10.1 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...

(July 2016) In my antenatal breastfeeding sessions one of the most common subjects brought up independently is that of safe sleeping and the avoidance of cot death, also known as sudden infant death syndrome (SIDS). There is invariably thinly disguised fear evident in the room combined with, in my experience, a desire to talk about it but avoid it at the same time. After all, talking about the potential death of a child makes for uncomfortable discussion. Currently in the UK there are approximately 288 unexplained infant deaths per year. This includes babies 0-12 months though a small percentage of the total (6.6%) were between 12 and 24 months. Since the launch of a safety campaign (Back to Sleep) in 1991, the incidence of cot death has reduced by 65%. Recommendations include primarily putting the baby to sleep on their back, in the same room as the parents for the first 6 months of life with their feet to the bottom of the bed. Further research has added to the recommendation...

(April 2015) Contrary to the information the media would have us believe, a majority of women still will go into labour without the need for induction and will give birth vaginally (NICE 2014). Currently however most of those women will also birth in an obstetric unit, though hopefully the dissemination of the new NICE guidance will start to have an impact of chosen place of birth given that around 45% of women are at low risk of complications in labour. So it would seem that most midwifery care in labour is given to women on a high risk unit at present. As a student midwives we are taught about the normal physiology of birth, that the mechanism of labour is facilitated by a delicate balance of hormones and that oxytocin is an element to be treasured and worked with. Of course we are also taught about when labour and birth takes a more complicated route and what action to take in those situations, and the inclination sometimes is to imagine that all normality is left behind in t...

I haven't updated this blog for a little while but it seems fitting to break the fast with the wonderful news today that NICE guidance has finally been updated to reflect the evidence surrounding birthing at home, one to one midwifery care, delayed cord clamping and minimising separation of mother and baby. You can view the updated guidance here: http://www.nice.org.uk/guidance/CG190 While I am over the moon at the update I can't help the feeling that this is a little like teaching Grandma to suck eggs and actually most of this is good old fashioned excellent midwifery philosophy already but it would seem churlish to point this out at length. What is key however is that while much of it is midwifery wisdom - what midwife will argue that one to one care and keeping mother and baby together needs new research and evidence to inform our practice with this - it is not yet in the public forum. Women have been scared out of having their babies at home and this latest guidance...