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Archive for November, 2007

Sunday is family day

Today has been a minimised family meal. I decided to try being a ‘mini’ domestic goddess and make, from scratch, two different puddings. My first choice was apple cake, a known family favourite, and easy as we still had cooking apples on the tree, and then I saw a recipe for Panforte. Mmm, that looks tasty, I thought, didn’t seem too difficult. Zoomed to Tesco’s, plain chocolate, runny honey, cocoa. Got back, checked the recipe again, ‘blow, blow ,blow,’ I forgot the rice paper. Back in the car, local store, no rice paper, back to Tesco’s, now teeming with eager shoppers. Rice paper, where do they have it, they must have it. Ask assistant, it’s not called ‘rice paper’ anymore, now it’s wafer paper, but they did have it. I am so sad that I carried it around the shop like a pennant, one so they didn’t think I was shoplifting but also so that people would know that I baked! I will never bake it again, it’s messy and cleaning the utensils takes serious elbow grease. Family meal, oh yes, Jack, Izzy and their Mummy and Daddy couldn’t come because of a prior engagement and Amy’s Daddy didn’t come due to a ‘foot in the mouth’ incident yesterday which has resulted in an icy 24 hours between him and daughter. It was a case of a man not thinking before he spoke, and then refusing to accept that what he had said was hurtful. Talking of icy, it’s snowing here at the moment, only settling on cars and my head at the moment. Yeah, Christmas is coming, and to really bring that home Amy is in her nursery nativity play, and is an angel. I’m really looking forward to being the proud Nanny and watching her and her friends.

I’m used to people asking questions at clinic, and I usually have an answer but I was stumped the other day. Gestational diabetes, how does the pregnancy affect the pancreas? ‘Oh bloody hell’ was my response ‘I have no idea. Now I’m going to have to find out’. The couple laughed, and the women said I should just have blagged my way out. I said that unfortunately that’s not my personality, I hate not having answers, to anything, it could be a question or just if I can’t find something. I have found two sites which give me an answer, one of them even tests me to check how much of the information I’ve assimilated!

snow.jpg

A snowy car!

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There was just so much on what to do with a placenta…….that I just had to go hunting for a few more childbirth rituals.

Guatemala – If the baby will not come, a common remedy is to boil a purple onion in beer and have the woman drink the liquid.
– Midwives believe the placenta needs the “heat” of the newborn to deliver, and if the cord is cut beforehand, the placenta will rise into the throat of the mother and choke her. If she must cut the cord prior to the placenta delivering, the midwife ties it to the mother’s leg with a strong stout string, using many knots to keep it from rising.
– Soon after the birth, the mother eats hot chocolate and sweet bread. She does not get out of bed for 24 hours. The only fluids she takes are hot chocolate, hot water and chamomile tea.
Central African Republic– A call-and-response song used during birth: “EI-OH mama ti mbi, ti mbi aso mbi” (“Ei-Oh mother of mine, my belly hurts me”). The response: “Kanda be ti MO!” (“Tie up your heart,” meaning “Tough it out”). Niger– In the Moslem tradition, a woman’s genitals are not to be touched by anyone other than the husband. The matrone (midwife) respects this custom and rather than “delivering” the infant, she aids the labouring woman by offering herbal drinks to stimulate contractions, sprinkles herbs over the woman’s abdomen, and recites prayers for a speedy, safe birth.Mexico – A pregnant woman should avoid all contact with anything death-related. She is forbidden from attending funerals or burials and from visiting cemeteries.
– During childbirth, it is thought that the woman’s womb loses heat and her ovaries and genitals soften, never returning to their original position. To prevent this, some traditional midwives place themselves between the woman’s legs at the moment she is giving birth, to help keep the heat in and curses out.
– During pregnancy, a woman must avoid cold or hot baths, using warm water instead. Cold water is believed to affect bones and joints; the pelvis will be rigid and this could cause a longer and more difficult and painful labor. And varicose veins and other circulatory problems seem to appear as a consequence of hot baths. Many also believe that a pregnant women should not expose herself to the sun’s heat or stand near a fire, since excess heat may burn the placenta or heat the baby and irritate it.
– A 40-day period of caring for the mother and child is considered essential for the prevention of diseases and complications
Peru – If the placenta doesn’t come out on its own, put salt on the woman’s tongue.

Angola– The Umbundu people do not take the new baby outside the home for the first seven days because they believe the child’s life is tenuous and bad luck might befall it.

Malaysia – The bleeding postpartum woman is considered polluted and polluting. At the same time, she is still vulnerable to evil spirits. Therefore she is forbidden to leave the house or participate in cooking and cleaning.

Ghana – The mother is to close or cross her legs during the postnatal period, based on the belief that it would reduce the air entering the body which could result in a bleeding and/or a permanently fat abdomen.

Inuit – If mothers begin a project such a sewing she should finish it so the labor won’t be long.
– Every newborn is greeted with a handshake by everyone, even the children.
– Don’t make bubbles with gum or blow up a balloon or your membranes won’t rupture.
– Don’t wear a ring or have braids in your hair because this will cause the umbilical cord to be wrapped around the baby’s neck.

Uganda – The mother is instructed not to drink water while standing, to prevent the baby from being born with squinted eyes.

Bolivia – Don’t do any knitting while you’re pregnant, as it will cause the umbilical cord to become wrapped around the baby’s neck.

Bihar, India -If a woman’s labour was not progressing she was made to drink a glass of water in which her mother-in-law’s big toe had been dipped.

Bali – The Balinese mother is purified twelve days after the child’s birth.  The placenta is buried with other appropriate offerings.  For the first one hundred five days of the child’s life he doesn’t touch the ground.  The child is held continuously in the arms of family until another ceremony which introduces the child to the family.

Navajo –  view of pregnancy is as a state of wellness and everything that the expectant mother does is for the well being of the fetus and the mother.  She is to exercise and do chores but nothing heavy.  She is not to be around anyone or thing that is dead or even go to funerals.  A Ceremony called the Blessingway is done by a holy man.  This puts the mother and baby in tune with the Holy people and causes balance.  All mothers are expected to breast feed their children so that the child will not take on the nature of the animal. The umbilical cord and placenta are buried near home so the child will always return home. The placenta also was buried next to objects of the profession the parents hoped that the child would become.  Sometimes it was given to the grandmother to discard. Or it could be buried in the fire of by the Hogan to ward off evil spirits.  The child is introduced into the community with a baby shower and a Blessingway ceremony

For Iranian rituals associated with birth – http://www.iranchamber.com/culture/articles/rituals_of_birth_birthday.php

Some of these make a lot of sense, or you can see their origins.

If the second (pushing) stage is prolonged violent vomitting can shift baby down. I would think that drinking boiled onion and beer would be a very good emetic, as would the thought of drinking water that anyone’s toenail had been in! Salt on the tongue could also induce vomitting and could cause a reluctant placenta to deliver.

Avoiding contact with dead bodies would also seem wise, infection is not a good idea during pregnancy.

I’ve saved the best until last –

Huichol Indians – The father traditionally sat above his labouring wife in the rafters of the hut, with a rope tied round his testicles. When his partner felt a painful contraction she would tug on the rope so he could experience, share her labour pains with her. How egalitarian of him!

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Look carefully I’m not finished with placentas yet. This one is keeping baby warm

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Family update

Jack – aged 3 and a half is at nursery 3 afternoons a week, and loves it. Today I took him and he disappeared at break-neck speed once we were in the school grounds, he couldn't wait to get his coat off and start playing. His sister, Isabel, or Izzy, is a little poppet. At 10 months she is tiny, a really petite little girl. She is crawling now but is never far away from her Mummy, there is a real love affair going on there. Izzy is 'double-jointed' which is at times really quite gross, thumbs go right back onto her wrists and her legs take on angles and positions which are freaky to observe.

Amy is not quite the butter-ball she was, thank heavens, her legs and tummy are slimming down nicely and she is just at the changing from toddler to little girl stage. Her Mummy says that she has spent too much time with me, she has all my mannerisms and sayings down to a T. We have a lovely relationship, she could be my favourite, but I try really hard not to have one grandchild I enjoy more than the others, perhaps it is just that we are so familiar with each other. Her brothers, the twins, Jamie and Louis are 12 weeks old now. Time has flown. They are the image of their sister, in other words little chubbies. It has become easier to tell them apart, if you know them, but Hubby and Son still get it wrong as often as they are right. Last week they both developed bronchiolitis and so spent the best part of a week in hospital between them. Traumatic time, trying to juggle the childcare. Amy's nursery have been amazing. She goes two mornings a week but since all the problems with Louis, queries about his hearing, spina bifida occulta and a heart murmur and then daughter becoming quite low due to worries and an almost total lack of sleep, they asked if they could have her on a Friday as well because she is 'so lovely and really helpful.' 

 

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Placentae

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The twins placenta, although, apart from the 2 cords it looks just like any other. This is how it would look to you if you were inside the uterus, it’s the baby’s side. The greyish/white covering is actually the membranes, the sac, there are 2 of them, the chorion which is the outer one, and the amnion which is the inner one.

inside-a-placenta.jpg

This is the inner surface and it is attached to the wall of the womb. It is implanted into the tissue of the uterus and it basically peels off when the size of the uterus reduces. A placenta is usually about the size of a small dinner plate so you can see why bleeding following birth can be massive, imagine that where the afterbirth comes from is a huge wound and it’s easy to understand why, if the uterus doesn’t contract down tightly, there can be rapid blood loss, a postpartum haemorrhage, PPH.

Anyone feeling squeamish? When I was a new student midwife I hated placentae. They had a strange odour, were mucky, cold and I was expected to handle them. This wasn’t some strange initiation, it is part and parcel of the tasks following a birth. The placenta has to be checked, are the membranes intact or are they ragged? If they are ragged then there is a chance of bleeding or infection. How about the placenta itself, is it all there? In the second picture a small lobe of placenta can be seen a couple of inches away from the main body, but attached by blood vessels. This lobe could have been left behind, undetected it would have prevented the uterus from contracting down and this would have precipitated a PPH. However, when examining the placenta all the edges are checked, attention being paid to if there are any blood vessels which come to a sudden end.

The cord, umbilical cord is also checked. Does it look normal, are there any knots in it? How many blood vessels are there, there should be 3, 2 arteries and a vein.

cord.jpg Cross section of a umbilical cord true-knot.jpgA true knot

It may also be necessary to take blood from the cord, perhaps there are concerns that baby may have been compromised during labour or birth, cord blood gases can indicate if baby has been affected and may require intensive care. Mum may be rhesus negative, we need to know what baby’s blood group is, the blood in the cord will tell us this.

My attitude toward the placenta has softened, it does help that when I touch them  they are warm, but I now appreciate quite how amazing they are. With all the technology we have there is nothing that can do the same job as a placenta, without it a baby wouldn’t start growing and a successful pregnancy is dependent on a healthy placenta, it is an amazing life-support system. Researchers are now finding out that it is even more wonderful, even more sci-fi, it hides itself and the baby from the Mother’s immune system and so protects from rejection. It has long been believed that eating the placenta can reduce the risk of postnatal depression, I can’t say that it appeals to me, but if anyone out there fancies cooking up a feast then here’s a link to some recipes. Mmmmm, placenta lasagne, tasty! I wonder if that is how Tom Cruise enjoyed Suri’s afterbirth?

So, having been tongue-in-cheek about munching on a placenta, or placentophagia what did I do with my Grandchildren’s placentae? Being a silly, sentimental old fool I bought them home, buried them in the garden and planted the area with flowers that would bloom, be at their best, at the time the afterbirths had finished their work of growing my Grandchildren. I am not alone in celebrating their part in creating a healthy baby. In the Philippines the placenta is buried on the seashore in the belief it bestows good health on the baby. In Vietnam the placenta is buried under the Mother’s bed, obviously acknowledging it’s significance to the baby. Hawaiian culture best sums up my feelings about the placenta, they bury it and plant a tree over it, as they perceive it as part of the child. There are ten’s of traditions involving the placenta, one acquiring popularity at the present time is lotus birthing, I can see possible problems, but the reason I wouldn’t want it for me, or mine, is that I know what an umbilical cord smells like just before it separates, rank.

I’ve enjoyed writing this, there is so much information about customs and beliefs concerning placentae, it has really re-inforced my wonder about this basic looking companion to a baby.

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Wasting money in the NHS

Waste money + NHS? What’s that about? Well, if you have any ideas about how to save money, and what wastes money in that august body, but no one seems to listen, well here’s your chance to air your ideas (managers need not respond, I’ve had enough of your money saving schemes, on the whole they do not benefit patients or staff). ITV’s Tonight are looking into how large public bodies waste money –

Waste Watchers
If you work in, or are a user of, the NHS and  if you  think you’ve come across an example of money being wasted ,  then please email us at tonight@itv.com.   We promise to keep your identity confidential.

I love the way they phrase it, ‘think‘, there is no ‘think’ about it, money is wasted. Away days/weekends for managers; catered lunches, for managers, doctors, and the Trust board; all those alcohol gel dispensers for ‘cleaning’ hands when soap and water works better at eliminating C.Difficile. How’s that for starters? Anyone else got any ideas?

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Yippee

Louis is home. The boys are reunited and Amy has her Mummy back!

Work today was relatively relaxed, sub-text means that I finished on time! I have been musing about 3 of the ladies that I saw at clinic,all had SPD or, as we now label it, pelvic girdle pain. Certainly this is a more accurate description as this condition involves the whole pelvis rather than just the symphysis. I am just amazed at how much more common this sometimes disabling condition has become. I do believe that modern lifestyle plays a part in the increase in the number of women experiencing it as I can’t think of any other reason why so many more pregnant women are presenting with it. During my updates last week we had a talk from a physio specialising in women’s health. Yes, there were reminders about pelvic floor exercises but she then went on to discuss pelvic girdle pain and one of her theories for it’s increased prevalance is women working later in their pregnancies. Of the 3 women I saw today with SPD 1 was a ‘stay at home Mum’ with a toddler, he requires carrying everywhere, on one hip, and the other 2 were 36 & 34 weeks, still working, taking the train and tube (lots of standing) and carrying briefcases and laptops (unbalanced loads). These examples would appear to support the physio’s supposition so how should I advise women? Stop working, start your maternity leave early, make your child walk, use a wheeled bag to carry your laptop etc., at least that is better than ‘we can’t do anything for you’ but it amounts to about the same thing.

To end on a really positive note. I booked a woman, L, today. She had been really patient as our first contact had been cancelled due to my shingles, then she was on holiday, and when I phoned her the other day, on my day off, to finalise our meeting Amy was in the background playing ‘copycat’ and echoing everything I said. Anyway, at the end of todays meeting L expressed her joy at being pregnant by saying ‘It’s like Christmas everyday’, it made her joy quite infectious.

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The boys are really fulfilling their description of ‘identical’ twins. Today Jamie was discharged from hospital……….and Louis was admitted. Poor old daughter had about half an hour when she thought she would be coming home, then the Docs saw Louis and she was destined to stay in hospital. There was some good news, Louis has been passed perfect, his ‘occult spina bifida’ is nothing to worry about, other than a slight risk of infection, and his heart murmur has disappeared! When the ‘team’ were doing their rounds they were accompanied by 2 medical students, apparently the boys were a big hit as they could compare the breathing, lung sounds between identical babies, excellent teaching material. Later the students returned and spent an hour examining them in detail an taking a comprehensive history of the whole family.

Other than feeling as if an angry horse has kicked me the stomach I am well but still steering clear of eating anything more than toast. I had Amy again today, we are becoming quite the odd couple, chattering away and playing Amy’s favourite game, invisible pets. She has an extremely active imagination, which can sometimes cause problems. I’m not always sure what we are playing with, as it’s invisible, and Amy’s speech can be difficult to understand. I really hadn’t anticipated that a lion might be coming into the kitchen to eat a baby duckling whose Mummy had gone shopping!

Back in the world of midwifery and the maternity services I found thispaper about working conditions and the quality of care, it was published in 1999 and what struck me was that nothing has changed, in fact the situation has worsened. There were sections which really jolted me as it was reading what I have blogged on lots of occassions, the piecemeal approach to implementing change, the reliance on staff goodwill, the essential downgrading of midwives etc. It is long, 72 pages, but well written and researched, every maternity unit in the UK was asked to contribute, 50% did. Any student who is commenting on ‘Changing Childbirth’, and the constraints affecting the success of achieving the targets, will certainly find a great deal to discuss in this paper.

 

 

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