SIDS and Co-sleeping

I awoke the other morning In a hotel turned on the TV and was confronted with the scare stories about co-sleeping (parent sleeping with baby in bed). The headlines shout out “Half of cot deaths when baby with parent” “ Co-sleeping is key culprit in sudden infant death” . These are terrifying headlines for many new mums. They cuddle and breastfeed their bundle of joy to sleep and as soon as they put the baby into the cot he opens his eyes and starts to wail. This happens for hours on end, mum gets exhausted and eventually decided to put baby in bed next to her as she has found that baby will sleep there or she will sit on the sofa for hours on end and occasionally fall asleep from sheer exhaustion.
I was disturbed by these headlines and the potential harm they could do to mums and babies, so I decided to read the original research and related articles. The original research was published in the British Medical Journal. The actual research findings show that there is a significantly incresed risk of SIDS (also known as cot death) if parent and baby are co-sleeping AND under the influence alcohol or drugs (prescription or illegal). There was also a high risk of SIDS if the baby was sleeping on a sofa with a parent. The conclusion to the research actually states that we should not frighten parents from sharing a bed with their baby.

“Based on evidence from research into SIDS it is questionable whether advice to avoid bed sharing is generalisable and whether such a simplistic approach would do no harm. Parents of young infants need to feed them during the night, sometimes several times, and if we demonise the parents’ bed we may be in danger of the sofa being chosen. A better approach may be to warn parents of the specific circumstances that put infants at risk. Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa. Parents also need to be reminded that they should never cosleep with an infant in any environment if they have consumed alcohol or drugs.”

A statement from UNICEF http://www.babyfriendly.org.uk/items/research_detail.asp?item=76 highlights the fact that the description of cosleeping include those babies that were sleeping on a sofa with parents (which is a very risky activity). When the figures were adjusted to exclude those babies that were 'co-sleeping' on a sofa and who were co-sleeping with a parent who had been drinking or taken drugs, the percentage of babies who died whilst sharing a bed with parents and the percentage of babies who died in a cot was the same. Therefore safe co-sleeping was at least as safe as cot sleeping (in parents room)
So given that it is far safer to co-sleep than risk falling asleep on a sofa or chair how can you make co-sleeping as safe as possible.
UNICEF produce a leaflet http://www.babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf about bed sharing which contains the following information.
The mattress must be firm and flat – waterbeds, bean bags and sagging mattresses are not suitable;

Make sure that your baby can’t fall out of bed or get stuck between the mattress and the wall;

The room must not be too hot (16–18°C is ideal);

Your baby should not be overdressed – he should not wear any more clothes than you would wear in bed yourself;

The covers must not overheat the baby or cover the baby’s head;

Your baby must not be left alone in or on the bed as even very young babies can wriggle into dangerous positions;

Your partner should know if your baby is in the bed;

If an older child is also sharing your bed, you or your partner should sleep between the child and the baby;

Pets should not share a bed with your baby

MOST IMPORTANTLY, NEVER share a bed with your baby if you have been drinking alcohol; taken any illegal drugs or any other medication which may make you drowsy.
I hope this information reassures some mums, I know that co-sleeping saved my sanity when coping with a toddler who didn't nap in the day time and a new baby. It has also been shown that co-sleeping is associated with an increase in breastfeeding, which can only be a good thing.

Active Birth

I'm getting excited, i'm off to an active birth workshop for the next couple of days. The workshop is run by Andrea Robertson who is an "independent consultant in childbirth education with over 30 years of experience presenting workshops and speaking at events in many countries around the world.
She is the author of 6 books, including the best selling Preparing for Birth: Mothers and Preparing for Birth: Fathers, The Midwife Companion – the art of support during birth and Empowering Women – teaching active birth. Andrea is based in Sydney, Australia. " Andrea is making a special trip over to Europe to run several workshops. The workshop i am going on is entitled empowering midwives to empower women during birth and it will cover 'rediscovering the pelvis, empowering and motivating parents towards normal birth, working with pain in labour, self help ideas for labour, plus much more! I always come away from workshops like this full of the joys of birth and excited to pass on the knowledge that i have gained. I can't wait to share with the couples who come to my antenatal sessions :)

Informed choice

My clients often opt for home birth, which I attend and I also carry out all postnatal care. Women often book me for a second pregnancy as they have been disappointed by the care they received in their first pregnancy. Many didn't see the same midwife twice and often felt pressured into an avenue of care that they really didn't want to follow and weren't allowed to make a fully informed choice. A wise midwife called Mary Cronk (MBE) often reminds women that they have the absolute right to refuse any proceedure for any or no reason, I will quote directly from mary as she has a wonderful turn of phrase.

“The law, and good practice is quite clear. A sensible person will listen carefully to any explanations to why a procedure is proposed, and then should she choose not to have XY or Z she just says no or no thank you. The "allowing" is done by YOU. An asssertive approach is worth cultivating. You may care to commit the following phrases to memory and practice them frequently in front of a mirror.

1. 
   “Thank you so much Midwife Sinister/ Mr Hi-an-my-tee, for your advice. We will consider this carefully and let you know our decision.” Sweet Smile!This one is most useful in the antenatal stage, though it can be used in labour. It can just take a minute to consider what you either want to know, or what you decide.
2. 
   “Would you like to reconsider what you have just said!” Fierce glare.This is useful and, for example, applies to the misuse of the word "allow".
3. 
   “I do not believe you can have heard what I have just said. Shall I repeat myself? ”
4. 
   “I am afraid I will have to regard any further discussion as harrassment.”This is used if the person does not respect your decision or persists in pressing the subject.
5. 
   “What is your NMC or GMC pin number?” This is used if 4 is ineffective. If the person asks why you want their pin number, inform them that this is something they might like to consider.
6. 
   “STOP THIS AT ONCE”.This to be used in extremis. I am delighted to tell you that this was used AGAINST me by a woman to whom I had taught it. I was doing a difficult VE (Vaginal examination) and was being too persistent. I stopped at once and learnt a lesson.

Do not argue; learn the phrases and keep them or similar for use if necessary. I am informed that it is usually only necessary to be assertive once or twice to have a much more respectful attitude from the people who are actually your professional SERVANTS. "

Addendum

I have re read my last entry and realised that i went off at a bit of a tangent!

I have decided to take a step back from full independent midwifery. There are several reasons, the main reason is my children. they are still so small and I want to spend more time at home with them. To be an IM means that I need to have childcare available 24/7 so I can head out at the drop of a hat if necessary. this means I need to pay a retainer to our child minder even if i didn't send my son, so she kept his place. to do this I needed to earn a certain level of money just to pay for childcare. This meant I was out working more than I wanted to. Also something always needed to be done, letter to write, notes to file etc. so even when i was at home my mind was else where and I was missing my kids growing up. The third reason is the thing that's affecting us all, the credit crunch. Enquiries have been very slow this year, everyone is feeling the pinch. Those women who have had Independent Midwifery care would class it as an essential but I suspect that if someone hasn't expereienced one to one care in pregnancy and birth they don't realise what a difference it makes to your emotional well being. I hope that one day when my kids can fend for themselves I can get out there and work full time as an independent midwife. In the meantime i get my fill of birth from doing some bank work at a local hospital birth unit and from passed clients who book me if they have another baby.

A change of direction

This week I will discharge my one and only client. I have taken the decision to step back from Independent midwifery for a while and not to take on any new clients (although the bond I have with my past clients means I would happily take them on if they fell pregnant again and asked me to care for them!). It has taken me a long time to come to this decision because I love independent midwifery so much, the relationships I have with clients are very special. They invite me into their homes, give me tea and pour out their hearts, then we wait for the baby, I get so excited if my phone rings in the middle of the night (which is usually when labour starts), and head out on an adventure to meet the baby that we have all been waiting for. Some labours are straight forward and go to plan and some veer off course and we need to go to hospital, but no matter what happens I am there for my client giving them space to make the decisions that helps them stay in control of the situation. Most women say that this control is the most important thing that determines how they feel about their labour. Things were explained and they had the chance to make the right decision for them, even if that was only 2 minutes to talk things over or hours to go through all the options. The time to support a woman to make an informed choice is one of the luxuries that I have working outside of the NHS.

There are many wonderful midwives within the NHS who are incredibly supportive of womens choice however NHS midwives are often restricted by time and resources. In many areas antenatal appointments are reduced, especially for women in their second or subsequent pregnancy. Antenatal classes have been cut back and number of women in each session increasing. This means that women and their partners are not getting the chance to consider their options for labour and birth and the early days with baby. This is the reason that I have decided to concentrate on running informative antenatal classes which are designed for small groups to explore all the area of pregnancy, birth and early days with baby.

Buggyfit

On saturday I attended a training so I am able to teach buggyfit, which is a safe postnatal exercise class, involving power walking and strength training. I am so excited about running these classes. It has been a long time since I was an aerobics instructor but on Saturday I realised how much I enjoy teaching exercise classes. I am planning to start with 2 classes; Monday in Market Bosworth and Wednesday in Hinckley Hollycroft park. These classes are run with new mums in mind so we focus on rebalancing the body after birth, and protecting the back which is a particular area of weakness in new mums. Mums need to have seen their GP for a 6 week check and fill in the health screening questionaire which can be found http://willowtreemidwifery.homestead.com/page05.html along with all other information for the class. Although the class is aimed at new mums mums with older kids in buggys are also welcome and I know of a couple of childminders who are interested in attending too. We do ask that all children are in buggys as the walking pace is quite fast and a child will struggle to keep up. We also ask that mums don't use buggy boards during the class as we focus on good posture and unfortunately buggyboards don't help this.

Now i need to spread the word!!

Well here we go, my first foray into blogging. Hopefully this will be all about midwifery, breastfeeding and any other random musings on related subjects. I plan to highlight relavent news articles and interesting stuff I find online.