Archive | August, 2014

Early labour and then Vaka is born in Queen Mary Hospital

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Early labour and then Vaka is born in Queen Mary Hospital

Posted on 20 August 2014 by hulda

 

 

Birthing pool

It takes around 20 minutes to get the pool ready

DSCN4361

Everyone participating in getting the pool ready
For labour

The boat looked like a war zone, – not a birthing unit

I had my last baby three years ago.  It was a challenging time in my life for various reasons and I had no time really to think about preparing for it.  Like everyone else who´s career and family are busy, I was juggling too many things at the same time and had to rely on family members and new staff members in my clinic to support me during these times. It worked out fine, but it was stressful and made me realise that all of what I keep preaching to other mums, really applies to myself as well.

 

Pre labour and preparation of the birth of Vaka

Pre labour and preparation of the birth of Vaka

I had wanted a homebirth.  The main reasons were that I wanted my family around me and I wanted no restrictions to mobility and I wanted quiet and calm surroundings.  I did not need to hear that I was a high risk case, obese with huge baby and liver problems and risks of all sorts of things, because I knew most of it (aside from the BMI) was not a problem.  Although I knew certain precautions were needed, I was hoping to get safe care but the birth environment that suited. The only midwife in Hong Kong who would support this was away for the Easter holiday but this was no problem for me, as I was not due till 10 days after Easter and with all three older kids I had been induced and very overdue.  So I told the midwife not to worry, I would wait for her.  I also had a friend of mine coming, a midwife who was doing her Phd and was going to help me and my family around the birth.

 

All three of my previous births had been annoyingly late and as much as I really tried not to be induced, it became reality in all births.  I will write about each of them later, but essentially, I got to feel supported during most of it, which was really important and made my birth experience more pleasant.

 

Vaka is born in QMH

Labour is long and boring

My office manager at work had just resigned and a new one taken over and I had so much work to finish before the Easter holiday that I was rushing that Monday morning, to go to work. It was a beautiful day and I decided to take the motorcycle in, so I was going to wear my bike boots on the way.  For the very first time in my life, I could not get my socks on.  Something kept bothering me every time I leant over and tried to squeeze my toes into the socks, so eventually I gave up.  Everyone was busy in the boat (where I live); my in-laws had just arrived the night before from Iceland, my other kids were going to school, my husband and my father were preparing to leave to China, where they were going to spend the next three days. I laid down for a few minutes, trying to comprehend what was going on.  Something totally new to me.   I was 39 weeks pregnant and it just dawned on me that likely, I was in labour.

Trying to get my motorcycle gear on was not going to work.  Trying pretend that I was not in labour was not going to work, but I did feel like I was very much in an early stage and I really did not want the whole family all over me in this early stage.  Yet, I did need to try to stop my husband from driving 300 km north of Hong Kong in the next 30 minutes.

 

Lying down can be great at times

Lying down can be great at times

I walked out of the room and announced that I needed some help with something in the bedroom, could my husband help me.  He yelled back that he was in a rush to leave, what is it? Well, the cabinet needs a bit of fixing.  Cabinet?  Ask the boatboy to help, I really must leave now.  By this stage my mother in law looked at me with suspicion.  She could obviously sense that I was in labour.  So I gave up soon and told them that I was having some mild contractions, and perhaps my husband should not go to China.  He looked at me, tired.  Really, sure? I told them I thought that I was not doing anything much, but I just could not go to work. So could everyone just continue what they were doing and let me potter around.  Fair enough, they all started to do some boat maintainance.  Basically, tearing down the ceiling covers.  And soon, the boat was without any electricity, the water heater was not working and there was no way to even manually warm up the water.

My father, together with my husband, 3 children, in laws and the three helpers, was not wanting to leave either.  This was a real family feast!

My older kids opted out of school (13 and 14 years old), and my 3 year old was happy to inflate the pool.

I tried frantically to find a midwife who could help me to stay at home during this early stage.

It was Easter time and no one picked up the phone.  Even my doctor friends were away or unable to help.

In any case, I was not in all that much pain, and the main project was to try to find water to fill up the birthing pool for my first stage of labour.
Everything was a beautiful chaos, it was a good day and I had a good feeling.

 

…to be continued…

Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

 

 

 

 

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My child is biting…. what do I do?

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My child is biting…. what do I do?

Posted on 13 August 2014 by Kristrun

IMG_2162Let your child know immediately that biting is unacceptable. Use firm, short and simple commands: “No, no biting”. But don’t dwell on it, don’t shout and be careful not to scare your child. Distract the child and try to focus on something else almost in the same moment…. “look, the moon”, and walk away from the scene where the biting took place.Don’t explain why they should not bite, don’t say anything else about the biting and don’t mention it again. You are actively ignoring what happened, and that works! Praise the child for doing other, unrelated things. Make sure to support positive behavior and the child will be a lot less likely to bite again.Remember: toddlers don’t understand the concept of apology until the age of 3 or 4 (depends on the child). By spending time on forcing the toddler to say “I’m sorry”,  you are dwelling on the negative behavior and it’s a lot more likely to happen again. Children don’t care if the attention is positive or negative, just as long as they get your attention. Support and praise positive behavior and actively ignore bad behavior.
It works!
Conchita Amende
Specialist community health nurse (health visitor UK)
To book consultation with our health professional click the link – available as home visit, skype, phone or office visit.

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Routine checks and tests for babies – the first six months

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Routine checks and tests for babies – the first six months

Posted on 08 August 2014 by Kristrun


IMG_0676At birth, your baby will be assessed by the midwife caring for you and will be given an Apgar score at 1 and 5 minutes following birth. This involves assessment of your baby’s behavior, heart rate and breathing, the score is out of 10 and most babies will be given a score of 8 or 9 by 5 minutes following birth. Your baby will also be weighed, and have head circumference and body length measured. She may also be bathed. A Vitamin K injection will be recommended.

In hospital you will have a paediatrician assigned to you/chosen by you. He/she will check the baby & discharge you from the hospital usually between days 3 to 5 after birth. Vaccinations will be commenced including Hepatitis B & BCG(TB). You do have a say in whether your baby receives these vaccinations, however if you are choosing to decline the advice, make sure this is based on independent research and be informed about what it is that you declining. You will also need to discuss this with the paediatrician prior to discharge.

Your baby needs a checkup around day 7-10. Your midwife/health visitor can perform this check up during a home visit, unless the baby has jaundice or other problems when they left the hospital. Baby will need a weekly check (roughly) for around one month, then every two weeks, and then monthly from 2-6 months. If you have a private midwife to help you at home after the birth, she will weigh the baby, check reflexes, and do a PKU test. Her visits usually finish around week 3-4 and then you can see a doctor for vaccinations and Well Baby Clinics for weight checks between vaccination appointments. Baby needs a hearing test before one month old (usually done in hospitals at birth) and a thorough developmental check around 6 to 8 weeks.

In private clinics, it is usually doctors who do the vaccinations – can be a paediatrician or a family doctor (GP). Your doctor will start the 6-in-1 vaccination at 2 months, with two more injections at 4 and 6 months. The 6-in-1 (DPT-polio-Hib-Hep) protects babies against 6 diseases: diptheria, pertussis (whooping cough), tetanus, polio, HiB (haemophilus influenzae type b), and hepatitis B.

If you are using government services, all check-ups and vaccinations are available there for free (4-in-1: DPT, polio) but will not include the HiB vaccination – this you will need to get at a private clinic. So if you want to have the HiB vaccination, it may be worth considering going privately for the whole 6-in-1 series as although you can have most for free, you will still need to pay for the HiB privately, plus the consultation fee, which will work out only slightly less expensive than having the whole series privately, and will result in more trips out, plus an extra injection for baby.

The government clinic will give the Hepatitis B vaccination at 4 weeks; private doctors give it at 6 months (included in the 6-in-1 vaccination).

Well Baby Clinics are available every week at Annerley for weight checks, consultation and development assessment and you can choose this option for regular weight checks in between your vaccination appointments. This is a lot less expensive than a trip to a private doctor and you will have access to our Health Visitor and midwives who can help and advise you on any of your baby related concerns or questions.

Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

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Medical Induction of labour

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Medical Induction of labour

Posted on 08 August 2014 by Kristrun

How is induction done?

Labour induction can be performed medically (artificially and drug induced) and non-medically. We will discuss how it can be performed medically first and try to set out some of the disadvantages and advantages of each method.

Prostaglandin gels or tablets

These are used more frequently when the cervix is not favorable, meaning that it is dilated less than 3 cm, hard, posterior, not effaced, or barely effaced, or any combination of the above. By using the Bishop’s score your midwife or obstetrician will decide if this is the best place to start. This can be used alone, or more frequently will be done 12 or more hours prior to the use of oxytocin. Frequently it will be given more than once over the course of an evening/night. A pessary or tampon like substance will be placed in or near your cervix during a vaginal examination.

Benefits: The more favorable your cervix, the less likely the induction is to “fail”. Sometimes this is all that is needed, other times oxytocin is also used. Can be done as an outpatient procedure.

Disadvantages: Takes longer to get into active labour, can be frustrating if your hospital policy is that you have to stay at the hospital during the waiting period. Sometimes the mother becomes nauseated or has headaches. This cannot be quite as controlled as oxytocin.

Breaking the bag of water (amniotic sac)

Using an instrument which looks rather like a crochet hook, your doctor or midwife will make a tiny tear in the bag of water. This will cause the water to begin leaking out. Since the bag does not have nerves, this should be no more painful than your average vaginal examination. The thought is that once the bag is ruptured, contractions will usually begin. In addition, the downward pressure of the presenting part e.g. the baby’s head, encourages the contractions to start.

Benefits: No drugs may be needed, you maintain more mobility than if you were required to have an intravenous drip or infusion.

Disadvantages: Contractions may not start, which means you may need other interventions such as the use of the hormone oxytocin (Syntocinon®). It may create an infection of the sac. The cushion for the baby is now removed. Rarely, but possibly, the prolapse of the cord (when the umbilical cord falls below the baby and is delivered before the baby, affecting blood supply to the baby), which means an immediate caesarean section is necessary.

Syntocinon®

This is an artificial version of the body’s hormone oxytocin. It is given by way of an IV infusion (via a drip or a pump) and is used to cause contractions. The amount of oxytocin used will depend on how your body accepts it. Generally, the amount is increased every 15-30 minutes until a good contraction pattern is achieved. Sometimes this is done in combination with breaking the water bag.

Benefits: A bit easier to control than say breaking the water, because the drug can be stopped by closing off the IV line. It can be turned off or stopped to allow you to rest or even go home.

Disadvantages: Can cause distress to the baby such as an increase or decrease in its heart rate. May not cause contractions. May cause too many contractions or contractions that last too long.

Where will I be induced?

It is usual for most medically assisted inductions to be performed in hospital. This allows both you and your baby to be easily monitored. Your midwife will need to monitor your baby’s heart constantly if you have an oxytocin (Syntocinon®) drip or infusion, or any prostaglandin drugs are given, but intermittent monitoring should be fine if your waters have broken.

Remember you don’t always have to be lying down to be monitored. Ask to be monitored while you are sitting in a chair, or even kneeling on the floor.

Will an induction be more painful than natural labour?

Not necessarily. It really depends more on your reasons for induction, the type of induction and whether or not your mobility is limited. Many women are able to be induced and still follow through with their plans for an unmedicated birth, though they can expect certain changes in their birth plans. If induction is suggested, gather facts and information, and ask questions. Why is it being suggested? How would it be attempted? What happens if it doesn’t work? What happens if you do nothing?

Consultation with the midwives, available on Skype (face time or other platforms), over the phone or in the office. Click here to book. More information about our services on our website.

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