Birth Manifesto

Birth Manifesto

A 14 point plan to improve maternity, labour and postnatal care  

1. 1.               Provide continuity and consistency of care and carer for pregnant women.
   2.              Enable all women to have the choice of home, birth centre and hospital births, ending the postcode lottery.
   3.              Normalise physiological birth by working to lower the emergency caesarean rates in the UK.
   4.              Fund doula support for vulnerable women, such as those at risk of domestic violence, refugees or women with perinatal depression.
   5.              Support independent midwives to practice, replace or reinstate the abolished Supervisor of Midwives tole and ensure regulation of midwives is fit for purpose.
   6.              Offer specialist perinatal mental healthcare across the country.
   7.             Ensure health professionals receive appropriate training and annual statutory updates on facilitating informed decision making, including an understanding of maternity care in a human rights context.
   8.              Reinstate grant funding of midwifery training.
   9.              Ensure optimal cord clamping is offered for babies, including those needing resuscitation.
   10.           Include the importance of an oxytocin-rich environment in the training of all birth professionals.
   11.           Fund community support for breastfeeding and infant feeding specialists and specialist midwives in hospitals.
   12.           Provide comprehensive antenatal and postnatal education for new parents.
   13.           Work to end the ethnic inequality in maternal and neonatal birth outcomes.
   14.           Celebrate birth as a positive experience to be honoured and respected.

1. National Maternity Survey, recommendation 2.1: 'Every woman should have a midwife, who is part of a small team of 4 to 6 midwives based in the community who know the women and family, and can provide continuity throughout the pregnancy, birth and postnatally.' 
NICE CG190 1.1.19: 'Maternity services should: provide a model of care that supports one‑to‑one care in labour for all women.'

2. National Maternity Survey, recommendation 1.3:  'Women should be able to choose the provider of their antenatal, intrapartum and postnatal care and be in control of exercising those choices through their own NHS Personal Maternity Care Budget.'
NICE Guideline CG190 1.1.2: 'Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth.'

3. Quality watch: 'Apart from Italy, UK has high and increasing C-section rates relative to the Nordic countries. OCED statistics 2013' ASPH re NICE CG190:
  'Irrespective of population a commitment and belief underpinned by sound understanding of the physiological process of childbirth improves women's' ability to labour and birth normally.' 

4. Cochrane report: 'We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.' Also current project with Social Care in North Cambridge, findings not yet released.

5. IMUK: 'There is legislation in place to require all health professionals to have professional indemnity insurance. Our regulator, the Nursing and Midwifery Council (NMC), ruled in December 2016 that IMUK’s indemnity scheme was no longer sufficient, despite it having been deemed suitable by two independent actuaries. This decision is not based on evidence nor on our previous safety record. We have never received a complaint regarding our indemnity cover from either a client or another midwife. IMUK had chosen to use an indemnity product that mirrors the scheme used by the NHS.'

6.  National Maternity Survey, recommendation 4.1: 'There should be significant investment in perinatal mental health services in the community and in specialist care. '

7. NICE CG 138, 1.5.22: 'openly discuss and provide information about the risks, benefits and consequences of the investigation or treatment options (taking into account factors such as coexisting conditions and the patient's preferences)'

8. NHS:  If your course starts on or after 1 August 2017

You must be accepted for a place on a full or part-time NHS-funded course which will lead to you registering as a:

9. NICE CG190 1.14.14: 'Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster. If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice.'
BASICS: Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support trolley: 'The-state-of-the-art BASICS trolley can be manoeuvred alongside the bed for a normal delivery, as well as next to a caesarean section or assisted forceps delivery. This means that the baby can remain close to the mum at a time when she most wants to keep her newborn within sight. In addition, it means that the baby’s umbilical cord can be left intact, enabling doctors who believe delayed cord clamping offers benefits to babies, especially those who are weak or premature, to employ this technique while resuscitation takes place.'

10. BUCKLEY, S, AIMS JOURNAL 'The full expression of these labouring hormones requires specific conditions: that the labouring mother feels private, safe and unobserved. This basic need is recognised by traditional systems of maternity care, which prioritise the emotional well-being of the labouring woman and ensure that she is cared for in a familiar place with known and trusted helpers. These factors will keep her as calm and relaxed as possible, and her adrenaline levels low.'

11. Infant Feeding Survey, 2.5.6: 'These findings illustrate the fact that the main reason why so few mothers follow the recommendation of feeding exclusively until six months is due to the introduction of formula, either to replace or supplement breastmilk. Given that this is also associated with breastfeeding exclusively for a relatively short period, information and support for mothers in the early weeks to help them to breastfeed exclusively for longer is likely to have an impact.' 
NICE CG 37, 1.3.1: 'Breastfeeding support should be made available regardless of the location of care.' 1.3.3: 'All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.'
1.3.15: 'From the first feed, women should be offered skilled breastfeeding support (from a healthcare professional, mother‑to‑mother or peer support) to enable comfortable positioning of the mother and baby and to ensure that the baby attaches correctly to the breast to establish effective feeding and prevent concerns such as sore nipples.'
UNICEF Babyfriendly Initiative, Step 3: 'Implement evidence-based initiatives that support breastfeeding, including the Unicef UK Baby Friendly Initiative, across all maternity, health visiting, neonatal and children’s centre services.'

12. National Maternity Survey, recommendation 2.3: 'Community hubs should enable them to access care in the community from their midwife and from a range of others services, particularly for antenatal and postnatal care.' 
NICE CG 37, 1.1.5: Women should be offered relevant and timely information to enable them to promote their own and their babies' health and wellbeing and to recognise and respond to problems.

13. ONS: 'Babies born in 2013 had an infant mortality rate of 3.8 deaths per 1,000 live births, compared to 3.9 deaths per 1,000 live births for babies born in 2012. Pakistani, Black Caribbean and Black African babies (6.7, 6.6 and 6.3 deaths per 1,000 live births respectively) had the highest infant mortality rates.'

14. NICE CG190 1.1.12: Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion, and that appropriate informed consent is sought.
1.2.1: 'Treat all women in labour with respect. Ensure that the woman is in control of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To facilitate this, establish a rapport with the woman, ask her about her wants and expectations for labour, and be aware of the importance of tone and demeanour, and of the actual words used.' 

REFERENCES:

BUCKLEY, S, IN AIMS JOURNAL 23, n4: www.aims.org.uk/?Journal/Vol23No4/undisturbedBirth.htm
COCHRANE REPORT: http://www.cochrane.org/CD003766/PREG_continuous-support-for-women-during-childbirth
INDEPENDENT MIDWIVES UK: http://www.imuk.org.uk/news/judicial-review-to-protect-independent-midwifery-begins/
INFANT FEEDING SURVEY 2010: http://content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf
NATIONAL MATERNITY SURVEY 2015 : https://www.england.nhs.uk/mat-transformation/mat-review/
NHS: https://www.gov.uk/nhs-bursaries/eligibility
NICE: https://www.nice.org.uk/sharedlearning/providing-a-choice-of-a-midwifery-led-unit-birth-centre-for-women-with-low-risk-pregnancies 
https://www.nice.org.uk/guidance/cg37
https://www.nice.org.uk/guidance/cg138/
https://www.nice.org.uk/guidance/cg190
ONS: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/pregnancyandethnicfactorsinfluencingbirthsandinfantmortality/2015-10-14
QUALITY WATCH: http://www.qualitywatch.org.uk/indicator/international-comparisons-surgical-procedures 
UNICEF: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/call-to-action/

Labour and birth bead line

On our Doula training course we were introduced to the idea of a beaded birth line, where beads are used to represent the different stages and phases of labour.

Katherine Woodbury offers workshops on how to make a beaded birth line and bead lines for sale, see her site for details: http://www.beyondbirthing.co.uk/beyond-birthing-workshops-for-collegues.html

Here is my birth line and the story for each bead.

The silver balls represent changes in stages so we start off with the latent phase of the first stage, with amber representing the rests and ruby representing the contractions. See how the rest periods gradually become shorter as the contractions or surges start to come closer together. We then move through the silver bead into active labour, where the contractions, now represented by the oval pink beads are more intense, and the rests, the pink spheres, are shorter and more predictable. This continues until the mother is around ten centimetres dilated, represented by the round pink bead showing the open cervix. We then may see the transitional stage - a starfish representing the spiky nature of transition experienced by some women, before passing into the second stage of labour.

At the start of the second phase, there may be a 'rest and be thankful' pause, illustrated by the oval teal bead, before involuntary pushing starts which is shown by the regular silver and lilac beads. At crowning, shown by the red bead representing the sensation of crowning, the baby starts to pass through the last stage of his or her journey and is born - the little blue baby bead.

After the birth of the baby, the placenta will be born, shown by a large red bead and the golden hour occurs, represented by the large gold bead. After that are four pearly days of colostrum as the mother and baby move into their fourth trimester, shown by the large golden heart at the end.

Dealing with toddlers hitting and biting

Sometimes when a newborn comes along, older toddlers can react by changing their own behaviours to try and help them deal with the new situation. Biting and hitting are very common behaviours amongst 1-3 year olds, whether they are in a house with a new baby, or just growing up and challenging the boundaries set for them.

First try to consider why your child might be biting or hitting. Reasons can include:

* not being able to communicate their needs verbally
* feeling their space is being invaded by another person
* experimenting with new sensations or a feeling of control over someone else
* sensory overload - too much noise/light/stimulation
* are teething/needing oral stimulation
* wanting to show love or affection (yes, really, they may not realise how much it hurts)

Then look to see if there is a trigger for the behaviour - is it the same child, when your child is tired or bored, is it at a certain place like nursery or home or around a certain toy or activity? Try to remove or reduce the triggers if possible or if not, be even more vigilant when around the triggers to try and catch you child before they bite or hit - this is the most effective strategy.

When you child does bite or hit someone else, you can try to:

* respond with a firm 'no - biting/hitting hurts'. Use the same phrase consistently and share it with all your child's carers.
*tell your child what you do want them to do, 'use gentle hands' or 'smiling mouths', again being consistent with the phrase used.
* check on the other child's wellbeing and pay them attention. Ensure your child is not receiving all the attention (positive or negative) as this can reinforce the behaviours.
* explain very simply to your child the effect on the other person's feelings, 'Jenny is crying because biting hurts'. Avoid blaming your child or labelling them as 'naughty', instead talk (very briefly) about the behaviour.
* re-engage the child who has bitten/hit out in another activity.
* ensure that you are praising them when they are showing appropriate behaviours - be specific, 'I like it when you hug me', 'good gentle hands with the cat'.

Remember that all new behaviours take time to learn - there are no magic bullets. Often these behaviours reduce as your child becomes more verbally able, so if you are concerned that your child is having trouble communicating in an age-appropriate way, seek the advice of a speech and language therapist via your doctor or health visitor.

Books can be a great way of learning new behaviours, try sharing Teeth are Not for Biting, Hands are Not for Hitting, or No Biting regularly to reinforce the behaviours you do want to see.

There is little research on toddler biting, but the Early Years Childhood and Parenting Collaborative have brought together what research there is here. Interestingly, they note one study showing toddlers in a large nursery initiated an average of around 3 bites per 100 days in the nursery falling to about 0.5 bites per pre-schooler per 100 days, showing that this phase does usually pass!

Dunkirk Refugee Camp day 8

So my time here has come to an end. I've been pleased to pass my English group onto some lovely ladies from the adult learning centre, who will continue the outreach lessons with the women in the Women's Centre, as some don't want to access mixed gender classes or formal classes per se. I was very proud as they showed off the skills they have learnt over the last few days. In the Children's Centre we finished off our flower garden - the children loved collaging and were very dedicated and neat in their work.

If I didn't have children of my own I'd quit England and stay - it's such a transient group of volunteers that the long term wonder-workers have their work cut out for them. It's never just teaching, it's fixing the generator, making the oil fires work, and keeping track of all the resources which are 'Ali Baba'd' (stolen) from under our noses and out of our pockets.

Thank you for all your donations, they have been put to fantastic use buying resources for both the Women's and Children's Centres and have brought much needed fun and distraction into the lives of many.

Dunkirk refugee camp day 7 part 2

So, on a slightly more lighthearted note, I thought I'd share the current contents of my bag and pockets.

Pockets:
packs of tissues, for me and the children
handwash, used religiously
pack of bubbles - great for a quick kid distraction
charger cable and phone - charge where you can, when you can
vaseline for my poor chapped lips

Bag:
spoon, cup, plate - if food appears you want to be able to eat it
nail varnish - see bubbles above, but for the women
nail varnish remover and pads - some of the muslim women need to remove it to pray
sharpie and xl post its - my key teaching aid since the mini whiteboard walked
hairbrush - I am constantly in a hat/buff and my hair is wild under there
extra gloves - it is super cold
mini-notebook for Kurdish phrases (Choney Bashi, people!) and noting cabin numbers for emergency deliveries of blankets etc                        
more tissues - honestly, everyone has a cold and/or a cough
the last of my English chocolate

Dunkirk refugee camp day 7

So last night I got a call from a camp resident, as their friend, her child (daughter aged about 7) and husband had got stuck on a lorry headed the wrong way - to Paris not to London. I learnt today that they were stuck in the lorry and had to call the police to help them get out as they were suffocating. The police got them out but left them in Paris. After sneaking on a train to Lille, they ended up stuck there, an hour's drive or more from the camp. Hence the rescue mission to get them. Today I got the biggest hugs and kisses as a reward. I have heard about a family who didn't have anyone to contact who ended up spending 4 days walking back to the camp from Paris after a similar experience.

In the Children's Centre today we had a New Year's party for the children which they all enjoyed lots. Today I have been mainly laminating volunteer information signs to support the smooth running of the centre - always the teacher!

The camp was without electricity and running water this morning. Thankfully the problem was fixed at lunchtime as I think there would have been riots over the small supply of bottled water available. There is certainly a camp 'mafia', who control some access to supplies and there was a stabbing on site which was likely to have been related to smuggling. Mostly though, people are kind and generous and I get offered shares in food and someone even tried to give me a replacement pair of boots today as they had noticed the zips had gone on mine. It isn't perfect, but there is hot food, clean water, mostly sanitary toilets and oil for heaters. It's not the jungle.

Dunkirk refugee camp day 6

I would blog about today, but I have to now drive to Lille to pick up a family who got on a lorry going to Paris instead of the UK. Mum, dad and an under 10. As you do.

UPDATE:
Safely returned to the camp, including the 7 year old girl who'd also been in the lorry that went to Paris instead of the Uk.