Health care planning, assessment, support

HEALTH – Global Community Health Care Planning for Children & Families

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‘Protonic’ Peer Support is Priceless …

Hello my name is Sue Parker and I was invited by Deirdre Munro to write a blog for our Global Village Midwives to highlight how priceless positive ‘protonic’ peer support really is.

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In some cases, postnatal mental health care is something that still falls through the cracks.
With well-wishers saying ‘a healthy baby is all that matters’ and talking about the ‘sudden rush of love’ a parent feels upon seeing their baby for the first time, it is therefore no surprise that any parent who is struggling with their mental health not only feels incredibly isolated; but also guilty for not enjoying their new role as much as others expect them to.
The guilt and fear of judgement is often a principal factor in both mums and dads not seeking help from a Healthcare Professional (HCP). I wrestled with my mental health for months. It was a true tug-of-war and I was exhausted. Finally, I sought professional help in the form of Cognitive Behavioural Therapy (CBT) and I saw my GP whose conscientious care I am certainly grateful for.
However, it wasn’t just the therapy and antidepressants which helped me on my journey. Peer support was also a great comfort. I felt reassured that others had experienced the same highs and lows as me. I grew to learn that I wasn’t ‘abnormal’ or a ‘bad mother’ and (with the help of my CBT) I began to feel comfortable dismissing the intrusive thoughts as opposed to believing them to be fact.
I conducted some research and examined other published studies about the benefits of peer support. Largely, it was found that peer support is beneficial for those suffering with a mental health issue. It was because of this I created ‘Life With Baby’, an online peer support platform for anyone in Kent suffering from a postnatal mental health issue. We want to raise awareness of all postnatal mental health issues and make sure everyone feels welcome; mums, dads, family and friends. Through a community like this, people can talk to others, share information and find local services.

With this help to hand, sufferers are truly able to make choices about their care and find what works for them. I am confident that we are moving in the right direction to help each other and with the rise of social media, there are considerable benefits to us becoming more connected.

 

If you would like more information about Life With Baby, please see our Facebook page: (www.facebook.com/lifewithbabykent) or my About Me page: (https://about.me/sueparker)

“It didn’t hurt, it wasn’t meant to, was it, doctor?”

A review of “Childbirth without Fear” for Deirdre Munro Global Village Midwives @GlobalVillageMw
by @DouglasNatusch

Introduction

A young doctor was attending a birth in Whitechapel in London in the first half of the 20th Century. What he later wrote could be from a scene from the television series “Call the Midwife”. The mother lived in a poor household in the East End of London. The doctor recalled having to provide his own towel and soap when he arrived as she had none to offer him. Despite the poverty of the surroundings he recollected “I soon became conscious of a quiet kindliness in the atmosphere. In due course the baby was born. There was no fuss or noise.” The mother declined chloroform when offered and it was when he asked her why she did so, she explained “it didn’t hurt, it wasn’t meant to”. These words had a profound effect on that young doctor. He went on to develop ideas and changed his practice. A desire to spread his ideas led to him writing a book, ‘Natural Childbirth’ and later ‘Childbirth Without Fear”. He didn’t just write books however, he start a social movement with a powerful thread, still running through Midwifery and Obstetrics today. His name was Dr Grantley Dick-Read.

Hello 🙂 My name is Douglas Natusch. I am a Consultant in Anaesthetics and Pain Medicine in South Devon, UK. Delivering obstetric anaesthesia is a part of my role, one which I appreciate and value. I first came across Global Village Midwife after a post I had written on Twitter about the ‘Skin to Skin” campaign. When @DeirdreMunro asked if I would write a piece, I though it may be an opportunity to read ‘Childbirth Without Fear” and reflect on the book from the perspective of a current day anaesthetist.

Childbirth Without Fear

Obstetrics and childbirth as Grantley Dick-Read encountered in the first half of the century, was a very different world to the one he later aspired to achieve for the women he looked after. He deplored some contemporary views that women should know as little as possible about labour and leave things to interventions of (male) experts. He directly challenged his own profession and he also challenged practices in nursing and midwifery that he felt interfered with the relationship between mothers and their babies.

He describes deliveries at home and in hospital. What he describes is very far from current practice. In hospital he writes how women were often left alone and unprepared on wards during their first stage of labour as there was not enough staff to be with them. He wrote “I shudder when I pass the door of those wards where the women lie alone, enduring the first stage of labour”. Once ready to be delivered, women were moved to a birthing suite and inhalation anaesthetics like Chloroform or Ether were often offered in the second stage of labour. Dick-Read commented that with vaginal delivery under general anaesthesia, women missed seeing their baby born or hearing their first cry. He reflected sadly on a situation where he saw “Anaesthetics used in place of education, drugs an antidote for misunderstanding.” He was also concerned about over-intervention in the form of forceps and episiotomy as a consequence. During home deliveries he describes situations that varied but where sometimes unhelpful advice given by well meaning onlookers did not always creating a peaceful and relaxing environment for the mother.

Grantley Dick-Read believed and advocated empowering women to understand the process of labour, to understand their bodies and realised the importance of women learning to overcome fear of pain in labour. He wrote that when prepared and given the choice, “Women demand to stay conscious to see their babies born”. He postulated a Fear-Tension-Pain Syndrome that could be overcome with antenatal education and relaxation. The outcome of his method is best described by a experienced Midwife he quotes in his book, “the difference is the women. They seem to know their job before they start ; they know what first stage contractions are doing and realise it may be a long time before the “door is opened”. They understand why relaxation helps.”

He was an advocate of immediate mother and baby skin-to -skin’ contact at a time when that was not the norm. He said “there is no greater joy than that of a woman who sees her baby born and hold it in her hands whilst it is still linked to her body by the avenue through which its lifeblood surged from the selective source within her womb.” To my surprise, I realised he also encouraged breast feeding at a time when women were not encouraged to, or even actively discouraged ; “rooming in ” instead of babies being taken away to nurseries post delivery and fathers being present at the birth of their children. Much of what he advocated has become embedded into modern Midwifery and Obstetrics.

Dick-Read was also concerned about the effects of popular culture in literature and film that promoted a view that labour was inevitably painful and distressing.A deeply religious man he even questioned translations in the Bible implying childbirth was painful noting irregularities in translation of texts relating to childbirth. In short, he was promoting nothing less than a multi-dimensional or bio-psycho-social approach to pain in childbirth, decades before it was adopted in other areas of medicine. Sometimes what he writes seems remarkably current – not from around 60 years ago. At other times his language seems arcane. In context, he was born a Victorian and was a veteran of World War 1. Perhaps his lasting legacy is to have been an influence in the development of The National Childbirth, NCT which continues to provide education and support to women and their partners as well as helping change the attitudes and practices of professionals.

What was the reaction to his ideas at the time?

Although some of his ideas were accepted and adopted at the time, which he recognised and was pleased to see, many of his ideas aroused professional controversy which he openly discusses in his book. What seems to have distressed him particularly was being accused of denying women pain relief in labour. Anaesthesia for labour pain had until then been seen as a modern and humane medical advance. It had received royal assent when Queen Victoria delivered one of her children with the assistance of Chloroform. Little had changed however in the practice of anaesthesia in labour it seems, up to Dick-Read’s time. It was delivered largely by non-specialist doctors, often the doctor delivering the baby. It is possible on reflection to understand why any challenge to this practice could have been regarded as regressive, unscientific and possibly inhuman by some at the time. Dick-Read was clear his method would not suite all situations. He advocated analgesia or anaesthesia if labour was complex or associated with malpresentation. In his book he outlines many of the techniques of pain relief used today with the exception of TENS machines and epidurals which were yet to be available.

It had also been suggested what he was doing in practice was merely a variant of hypnosis. He spends time clarifying why this was not the case and outlines the methods of relaxation he promoted. Dick-Read was clearly an enthusiast for natural childbirth. My only qualm was perhaps the statistic where he states that in 90% of suitable women severe pain can be eliminated by “substituting understanding for fear”. He provides no evidence in the book to support this statistic.

Changes in pain relief techniques in labour since Dick-Read

What has changed profoundly from my perspective since ‘Childbirth Without Fear’ was published has been the development of an Anaesthetic profession which he may be surprised to realise teaches its trainees about his ideas on the psychological prophylaxis of pain and whose trainees are now nearly 50% women. Dick-Read wrote that “The most important factor in the use of anaesthesia and analgesia in childbirth is the skill, experience and judgement of the attendant”. The Anaesthetic profession has made great efforts to improve Obstetric Anaesthesia both in terms of training anaesthetists and delivering a safe service in the UK over the last 4 decades which has shown success in reducing maternal mortality from anaesthetic causes in UK national audits. General anaesthetics are no longer delivered by doctors without a professional training in anaesthetics. Standards for Anaesthetic training and professional practice for the UK are now set by the Royal College of Anaesthetists @RCoANews. General anaesthesia is not offered as an option for routine pain relief in labour. Anaesthetists are now embedded members of the delivery unit team and are involved in variety of ways from providing epidurals for pain relief through to Intensive Care, where units are largely run by specialised anaesthetists. There is now an Obstetric Anaesthetists Association, @OAAinfo which is a charity aiming to disseminate good practice in Obstetric Anaesthesia including producing resources for patients on pain relief in labour which can be found at http://www.labourpains.com/UI/Content/Content.aspx?ID=5

Despite advances in anaesthesia, both in terms of techniques and drugs, good tools of communication remain as important as good equipment in my experience. For me, technical expertise is not enough unless it is not delivered in a context of understanding, clear explanation and above all kindness. Anaesthetists are relating to women at a key time of their lives often to deliver complex interventions at short notice. The best time to have discussions about pain relief in labour is before labour and anaesthetists do join discussions in ante-natal classes, Anaesthetics are still not a substitute for education and drugs are still not a substitute for misunderstanding.

Perhaps the most important thing is for all the professions involved in childbirth is to, like Dick-Read, reflect on what they are doing now that is seen as ‘good clinical practice’ that may have unintended consequences and need to change. Feedback from women and their families needs to be embedded as an integral part of service development along with audit. Listening to his patient is what started the change for Grantley Dick-Read.

When I was first asked for my comment on the ‘Skin-to-skin’ campaign on Twitter, I wrote that ‘something profound happens to women when they meet their baby’ and that ‘I have no words for their transformation’. I still don’t. I had considered writing an essay on current ideas about the neurophysiology of fear and pain, but suffice to say the brain can and does powerfully module its own input and the emotion of fear does have a role. What would happen if we were ever able to capture an image of the moment in a woman’s brain when she meets her baby? Something very profound in terms of neuronal function and neurotransmitters release, I suspect, but personally I do not think medical imaging is necessary. If you have the privilege of being present when someone is born, just take notice. It may be the greatest privilege of your life.

Dr Douglas Natusch
Consultant Anaesthetics and Pain Medicine
Torbay and South Devon Foundation Trust
Torquay, Devon.

A review of ‘Childbirth without Fear’, Dr Grantley Dick-Read 4th Edition 1959 expressing my own views, not those of my employer for @GlobalVillageMw

No more Dr Google. Ask The Midwife instead!

HANNAH

 Ask The Midwife is the UK’s first ever health advice app that has been created and run by registered Midwives. The Founder of Ask The Midwife, Hannah Harvey, talks exclusively to Global Village Midwives on how she came up with this innovative idea…

 

Firstly, thank you so much for inviting me to write a blog post about Ask The Midwife. I have worked in the NHS as a midwife since I qualified five years ago. In my experience, midwives are extremely passionate about their work and want to provide the best care they possibly can. However, working in the NHS sometimes means this is physically impossible due to high workloads and staff shortages. This was really hard for me and many other midwives to deal with because we care so much about the work we do.

 

Two years ago I became a caseload midwife for young parents. Case loading means a woman has the same midwife all through pregnancy, birth and the postnatal period. Working in this way opened my eyes to how amazing continuity of care is. Having the constant ability to have a midwife on hand whenever you need it really benefitted the families under my care. I knew there wasn’t a way for me to ensure every woman in the UK received continuity of care, but I started to wonder whether there was anything I could do to make sure everyone had the opportunity to speak to a midwife when they needed to. And this is how Ask The Midwife was born!

 

I wanted it to be a service for everyone, which they could access any time they liked, which is why I developed an app. It means that women and their families can download the app and speak to a midwife at the touch of a button. There are two services within the app. An ASK service, where users can ask a question and get a response from a midwife. This service was created for users who have a niggling question that can be answered with a single answer. The second service is a CHAT option, where the user can chat with a midwife via a message system for 10 minutes about any issues arising in pregnancy, birth and beyond. All the midwives will offer advice based on the latest, evidence based practice.

 

I am hoping that Ask The Midwife will make a big difference to women and their families during pregnancy and after their baby is born. Women and their partners or families can ask us about things that are bothering them and we will get back to them within an hour (with CHAT) or within four hours (with ASK). Ask the Midwife could reduce pressure on the NHS and midwives working in the community and triage. With the latest information and evidence on Saving Babies Lives and maternal outcomes from NHS England, I am also hoping that we can help women make informed decisions that could save their own or their babies lives, such as seeking help when they are experiencing decreased movement of their baby.

 

For the last 8 months I have been working hard to bring Ask the Midwife to life. The app will be launched in May and you can find out more my following us on Facebook (/askthemidwifeuk) Twitter (@askmidwifeuk) or Instagram (@askthemidwifeuk). The app is free to download but there are small charges associated with each service because the qualified midwives on board need to be paid for their time. Subscription services are also available. I have worked hard to make it affordable for everyone because I am passionate about maternity care, women’s experiences, and giving women and their partners the advice they need, when they need it. I expect Ask The Midwife to make a difference for lots of people. We have an absolutely fantastic team of midwives on board who are as passionate and driven as me… who cannot wait to get started and are looking forward to helping women and their families across the whole of the UK.

 askthemidwifeiphone5-webaskthemidwifeiphone5-web

 

www.askthemidwife.co.uk

www.facebook.com/askthemidwifeuk

www.twitter.com/askmidwifeuk

www.instagram.com/askthemidwifeuk

 

 

World health innovation summit Day 1 Carlisle

Day 1

A fantastic mind blowing innovation summit occurred in CArlisle thanks to Gareth Presch, Krista and team.  I presented our Global village network story and show cased how the global village of midwives flourished in 1 year.

Sally Goodwin is described as our Global Village Professor of kindness.

Soni Cox founded and launched a new global village of mental health.

I met Twitterbuddies and lifelong friends innovators and philosophers.

Lots of ideas and new words exchanged;

myometrium moments = #myomo

innovation moments = #InoMo

oxytocin hug = #Oxyhug

 

 

The Universe & An Old Piano

“The universe is more like music than like matter”. – Donald Hatch Andrews

‘Be Humble for you are made of earth.
Be Noble for you are made of stars’. – Ancient Proverb

The Universe is an amazing place. It is billions of years old and seemingly started with the Big Bang. Hubble estimates there are 100 billion galaxies. It’s all so vast and yet so minute. The atom we discover as a dancing micro universe and the wider universe a magical sprawl of galaxies and constellations. Werner Heisenberg the German theoretical physicist summed it up so well when he said… ‘not only is the universe stranger than we think, it is stranger than we can think’. We are surrounded and filled with mystery and the mysterious.

In this blog we would like to fly our idea of inter-connectivity; interconnectivity as fact and as practice. We all experience separate identities and life as a series of ‘outside of us’ events. Yet there is also a unity and cross matrixing of all things. New quantum physics theory reveals matter is not composed of basic building blocks but complicated webs of relations. Interconnectedness lies at the core of all that exists. So we walk and live in connectedness. Carl Sagan made the point that we are stardust – born of stars and the universe. These big pictures should help dissolve the barriers and silos we create. It tells us that we are one at the level of our very being. We perhaps get a sense of this when we feel connected to others and to our own life. We feel we are all in this together and compose each other’s history and being. If we walk into a room of tension or sadness we can pick up the emotion. A smile or genuine kindness initiates real live connections and can ignite a ‘protonic charge’ thereby positivity emanates and spreads.

Inter connectivity is reality. We respectively urge we must make it our daily practice. The dilemma is we often don’t experience or create a space to believe in inter-connectivity. Our tribal templates create camps and rejection. There are however many examples to call us to new views. The scientist David Suzuki talks of the consciousness among aboriginal people; “Aboriginal people do not believe they end at their skin or fingertips” and he notes there is a deep link and listening to what surrounds them. If universe is more like music these folks know a lot about the song. And that’s the challenge – to hear that song and let music resonate through our being.

Inter-connectivity is a deep well where we can bring its healing and refreshment visibly into our thirsty broken world. Let it spring up in our homes, workplaces and in unlikely places. A friend of one of the authors many years ago offered to go to an elderly people’s home and play piano at Christmas. The home manager asked him how much he wanted to play and our friend smiled and said… ‘Nothing.’ He went and the place was dank and gloomy despite decorations. He sat down before an old piano and played. The room soon lit up. People sang and a sense of real connectivity flowed through the room. Perhaps for the first time in a long time some of these folks felt alive and joined to others in a common ground. An old piano was the medium for inter-connectivity to flow through that room lighting up people and hearts. Our friend was lit up too. The piano was the medium but it was his heart that was the key. This we call a true ‘myometrium moment’.

 

There is a big lesson here; Empathy and interconnection creates music for our souls and in a room with others a soul orchestra is created. It creates an identified interconnected space which generates in each of us a sense that we are not alone, we all belong, we intertwine.

The good news is that we can be all be Inter-Connectors in an interconnected universe. All we have to do is care and reach out. We may not always feel the connection – with some people we won’t always be able to make it. But that’s Ok. We will make that connection with many and then when we do the magic starts.

 

We hope as Christmas approaches the powerful currents of inter-connectivity flow through us all. When they do, they create many new magical myometrium moments. Happy Christmas! 🙂

 

Deirdre Munro & John Walsh