A letter to my head of midwifery

Hi HOM, 

As mentioned, I am writing to you regarding my birth choices and preferences. I want to ensure these are addressed prior to my estimated due date so we can work together effectively from a place of understanding.

Human rights law gives individuals the right to enjoy a private and family life. This means I have the right to choose who supports me during pregnancy and birth, and in the days following birth and my chosen birth place.

Firstly my perceived risk is due to having a caesarean birth previously. Due to PROM I was induced which resulted in a caesarean. Prior to the cascade of interventions my waters were clear and I was fit and well showing no signs of infection or concerns for babies welfare. Had I been presented with the research at the time to make an informed choice I would have chosen to stay at home and wait, unless concerns arose.

For this pregnancy, all is currently well with the pregnancy and no other perceived risks other than the previous caesarean and a perceived risk of scar rupture. It was a lower transverse incision, the evidence suggests the risk of this is 0.22% and so I am willing to take the 99.78% chance that this won’t happen to me. My background in tissue viability assures me that I have a healed well and allowed enough recovery minimise the risk further again. I discussed this with the obstetrician and I understood him to respect my choices and has hopefully emailed you with the outcome of our discussion. I have asked that unless something comes up in the pregnancy that this is not revisited as I feel there is nothing more to say. 

As a Trust I feel you need to consider the harm the restrictions of the home birth policy may cause as I appreciate restrictions can be put in place, especially around winter pressures. Research in this area has repeatedly demonstrated the benefits of being supported by loved ones and companions of choice during pregnancy and birth. I appreciate staffing may not facilitate a home birth however should no one be available I will be remaining at home with the support of my husband, family and Doula unless I feel the need to come into hospital due to any concerns that I may encounter.

I know questions will be raised around my preferences to not be monitored in labour and declining Vaginal examinations. I would like to make it clear I am informed in my choices and that to achieve the birth that I need to heal from my previous experience these choices need to be respected.

There is no research to date examining whether the practice of fetal heart rate auscultation improves outcomes, or the optimal frequency of auscultation and therefore unless I request it, I do not want to be pressured into monitoring of any kind.

Also to add, the idea that the cervix can tell a midwife about my progress in labour is underpinned by an incorrect understanding of birth physiology. Childbirth physiology is complex and I strongly believe that being left undisturbed optimises my birth experience, mentally, physically and spiritually. I've done a lot of Dr Rachel Reeds lessons in reclaiming childbirth and witnessed firsthand birth unfold beautifully without interruption so the belief that my instinct will prevail is strong and this is what we should be guided by.

I understand that I may need to make alternative decisions during my birth. I want us to work together to make sure I fully understand my options so I can make an informed decision however understanding my above preferences will make this easier and as a result I am confident that my birth will progress without complication.

A lot of self discovery and research has gone into creating my birth preferences which is why I know this is the best chance for me having a birth without trauma or complication.

It is also important to note that once baby has arrived, I do not want the immediate time to be disturbed unless I request it. The only hands touching the baby will be that of my own, my husband and possibly my daughter if she is awake. I do not require active management of the placenta and it is through my own experience that I wish for patience with its arrival as it often seems to come at approximately 90minutes after birth of baby, of course each individual is different. I would also like to keep my placenta. We will be using a cord tie and cutting the cord as a family once the cord is white and non pulsating.

I appreciate their is a lot here that your policy’s may not be supportive of however I am hoping that any midwives involved will be excited about the prospect of a true physiological birth and supporting me by hopefully having to do nothing but sit, listen and wait. I will have refreshments readily available. I also hope that having all of this documented on my health care record can facilitate this further again and reduce any anxieties around protecting NMC registration. I want the midwives to feel relaxed in supporting these choices that do not fall within their usual practice. 

I look forward to your response and chatting through this with you.

Yours sincerely,

Leanne

A Safe Space

It is important to know Doula Diary is a safe and non judgemental space!

This comes from me, being a human being and learning everyday about challenges we all face. This is a very open, wearing my heart on my sleeve kind of post. One I feel some of you will relate to and understand, and why I want to share.

I love my life, everything I have dreamed of has come true…is true. I’m living my dream. It’s not perfect but it’s what makes me happy. It’s a balancing act to juggle happiness, finance, home, work, family, life and as I grow and learn more about myself I understand more.

I have a roof over my head, a healthy body (granted I could do with more sleep and my body aches from time to time) a healthy family, supportive friends, an understanding husband, 2 wonderful dogs and the best clients who really make my work fulfilling.

So when it comes to that time of the month where as a women I bleed. Things get a little foggy. I get irritable, lack motivation and need space and time away from my family. The balancing act becomes overwhelming.

Did you know this is perfectly normal and valid for so many. Now my husband always worries as I naturally become distant. I’m reserving my energy. It’s hard work raising a spirited toddler who’s navigating her own emotions. To support my daughter with this it all starts and ends with me. Now I find it so so difficult to maintain this patience at this time of the month. I have to breathe and collect myself. Easier to do if I’ve had some headspace and filled my cup.

My husband asked me what he can do to help as he isn’t ‘Intuitive’ when it comes to stuff like this. I could have cried. I try to explain that it’s not him , our daughter or our life together. It’s my hormones, it’s my emotions, it’s who I am and always have been. Once upon a time it would have manifested so differently but now I have people who depend on me. But I still need space, and that is what he can do to help. Take our daughter and give me some space.

I may seem like a little bit of an ‘expert’ around birth. I’m not, I’m always learning, same with parenting. It’s a learning journey which we do better when we do it together and share. We have highs, we have lows.

Each Parent, baby and child is different and so is the journey. It will never be the same. So I want you to know that my inbox is always open if you need to splurge into a message how you are feeling. Do not worry about any typos, auto corrections (these can be quite funny and humour is powerful) or grammar. I don’t, it doesn’t matter in the grand scheme of things.

Pop me a little heart in the comments if you ever feel the same, or have anything to add. I would like to show my husband it’s not just me. I appreciate those of you who are pregnant won’t have a cycle right now but that feeling of being overwhelmed may still speak to you.

Lots of love

Leanne x

Nutrition, Wound Healing & Recovery

Nutrition plays an essential role in wound healing and care, and nutritional support needs to be considered a fundamental part of wound management. Poor nutrition before or during the healing process can delay healing and impair wound strength, making the wound more prone to breakdown.

For an adequate immune response, collagen synthesis and to transport oxygen to the wound, certain micronutrients are particularly important for wound healing (Munoz et al, 2020; Tuz and Mitchell, 2021).

These micronutrients include:

Vitamin C: fundamental for collagen formation and subsequent cross-linking, as well as the formation of new blood vessels (angiogenesis). Adequate Vitamin C levels will help strengthen the healing wound. Vitamin C deficiency has been found to impair wound healing and has also been associated with an increased risk of wound infection. Also helps Iron absorption.

Vitamin C is found mostly in fruit and vegetables, especially oranges, grapefruit, tomatoes, and leafy vegetables.

Zinc and copper: Found in small amounts in the body, it plays a role in wound healing. Zinc is involved in protein and collagen synthesis, and in tissue growth and healing. Zinc deficiency has been associated with delayed wound healing, reduced skin cell production and reduced wound strength.

Dietary zinc sources include red meat, fish and shellfish, milk products, poultry and eggs. Copper is found in highest amounts in protein foods like organ meats, shellfish, fish, nuts, and seeds as well as whole grains and chocolate.

Vitamin E: essential for optimal immune function and assists with healthy tissue formation

Vitamin E is found in plant-based oils, nuts, seeds, fruits, and vegetables.

Vitamin A: Increases the inflammatory response in wounds, stimulating collagen synthesis. Low vitamin A levels can result in delayed wound healing and susceptibility to infection. Serious stress or injury can cause an increase in vitamin A requirements. While the mechanisms of vitamin A in wound healing are still not well understood, it is clear that it plays an important role.

Vitamin A is found in milk, cheese, eggs, fish, dark green vegetables, oranges, red fruits and vegetables

Iron: is a mineral that provides oxygen to the site of the wound; therefore iron (haemoglobin) deficiency can impair healing. Iron deficiency can also result in impaired collagen production and strength of the wound.

The best sources of iron in the diet are red meat, offal, fish, eggs, wholemeal bread, dark green leafy vegetables, dried fruits, nuts and yeast extracts.

Protein: is essential for the maintenance and repair of body tissue. Low protein levels will cause a decrease in collagen development, slowing the wound healing process. Adequate protein levels will help achieve optimal wound healing rates. Overall energy intake is also important, because if energy needs aren’t met the body will use protein for energy rather than for wound healing.

Sources of protein include red and white meats, fish, eggs, liver, dairy products (milk, cheese, and yoghurt), soy beans, legumes, nuts and seeds

Healing Post Partum Bath Soak

Postpartum herbal soaks are a lovely, natural way to soothe tender, inflamed skin, heal tears, reduce hemorrhoids, and otherwise pamper yourself after you have your baby. I recommend a bath a day for no longer then 10 minutes to help soothe and heal your skin. It also offers you the opportunity for some much needed me time, medicine for mind & body.

I myself enjoyed a healing sitz bath after my daughter was born and I was recovering from an unplanned caesarean. After my initial dressing was removed from my caesarean site I would gently bathe then pat my wound dry with a clean towel. I would then apply some high waisted fresh cotton knickers (you don’t want anything rubbing on the scar line as this will aggregate the wound and could contribute to complications or delayed healing.

There are many variations of herbs that can be used. I have posted below a combination I like to to soothe tender perineal tissue, heal tears, episiotomies, promote caesarean scar healing and reduce inflammation, and even shrink hemorrhoids after a vaginal birth.

Preparing the bath is as simple as making a giant pot of tea, and the medicinal liquid can also be made into compresses if you are needing even more support for your perineum.

Red raspberry leaf is a super gentle yet effective herb that is a mineral-rich uterine tonic and a skin soother.

Herbs like chamomile, calendula, & witch hazel are antiseptic and great for increasing circulation to pelvic area.

Lavender has a relaxing floral scent. It promotes restfulness, and is antibacterial, antifungal, and an antioxidant.

Witch Hazel used for hemorrhoid relief and treatment is known for its anti-inflmmatory and healing properties.

Yarrow, Both the dried herb and flowers can be used with similar properties. Yarrow has wonderful antibacterial and antifungal compounds that are helpful in replenishing the interstinal flora. It is also helpful in stopping bleeding from haemorrhage.

Quantities.

* 1 cup or of Epsom Salt

* 1/4 cup of Red Rasperry Leaf

* 1/4 cup of Lavender

* 1/4 cup of Witch Hazel

* 1/4 cup of Yarrow

* 1/4 cup of Calendula

* 1/4 cup of Chamomile

Please note this is not medical advice.