Archive | January, 2017

Hypnobirthing and normal birth in government hospitals

Hypnobirthing and normal birth in government hospitals

Posted on 31 January 2017 by hulda

As you may know, the  government hospitals are constantly trying to increase their normal birth rates.  They have in the last 15 years introduced the birth balls in all labour rooms, the dad’s massage programme and labour position choice for birth.  You also all know that this is not always obvious, not always offered to you. In fact, you may have to ask for it more than once, but usually in the end, if you know this is possible, it will make your experience and outcomes much better.
Annerley Hypnobirthing Classes

Hypnobirthing in Hong Kong

Luckily for me, when I had my last baby in the Queen Mary Hospital I knew what to do and even if I was asked to stay on my back, I smiled politely and told them that I had been trained to be mobile, even with the IV lines and monitors attached to me.  Then I moved to my knees on the bed and was able to do pick any position I liked.  I guess I would not have done that so comfortably had I not known that it was possible.
What I am trying to say is that the staff is now allowed to allow you to be more free in your movements during labour, they are able to encourage more participation of the dads in the labour room and now, have one more addition:
HYPNOBIRTHING training for the midwives in government hospitals is in the cards.  The training course for the midwives is scheduled for April, meaning that hopefully you will be able to enjoy even more support from the staff, for breathing and relaxation during childbirth.  At Annerley we can do YOUR  part of the training, i.e. the classes that prepare you with the Hypnobirthing techniques.  And then you will know that you will be greeted by staff that knows how to follow up.  Hopefully many midwives will sign up for this course, offered by the Department of Obstetrics and Gynaecology.
What is also very important to know is that none of the above will actually ever become the NORM, unless you actively ask to use it.  I.e. now that it is allowed in the hospitals does not actually have to mean that all staff wants or is used to using it.  It means  you can ask for it and actively participate in helping the staff to train their own skills too.  This is a constant co-operation that needs all of us to participate in.
So again, I encourage all of you mums- and dads-to-be to be proactive, positive, and help others to help you.  Slowly good things happen.
Happy new year to all,
Hulda Thorey, midwife

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What is Is Delayed cord clamping and is it available in Hong Kong?

What is Is Delayed cord clamping and is it available in Hong Kong?

Posted on 11 January 2017 by Kristrun

delayed cord clamping

Delayed cord clamping – DCC

Delayed cord clamping (DCC)  is the practice of leaving the umbilical cord that supplies blood and nutrients to the baby, intact for several minutes following birth. The umbilical cord pulsates for some time after the birth and continues to propel blood into the infant. DCC has several benefits, including improving neonatal blood pressure and cerebral oxygen perfusion, as well as lowering the risk of necrotising enterocolitis.

The biological importance of DCC

The blood volume of the baby, the umbilical cord and placenta combined is around 450 mls. 300 mls is in the baby and 150 mls in the cord and placenta. This 450mls of blood does a circuit around the baby and placenta delivering oxygen and nutrient-rich blood to the baby and taking carbon dioxide rich blood away from the baby and back to the placenta.

DCC increases neonatal blood volume by up to 30% for children born at term and by 50% for preterm infants (compared with immediate cord clamping). DCC is associated with a wide range of neonatal benefits, including: improved neurodevelopment,  improved blood pressure; improved cerebral oxygen perfusion, and reduced need for blood transfusions due to decreased anaemia, increased level of stem cells and improved outcomes for premature babies.  WHO recommends DCC, not earlier than 1 minute after birth, “for improved maternal and infant health and nutrition outcomes”. The Royal College of Midwives (RCM) recommends between 1 and 5 minutes.

Long-term outcomes

DCC is associated with up to a 60% increase in red blood cells, higher haemoglobin levels at 24 to 48 hours of age, and increased serum ferritin levels at 4 to 6 months. DCC helps protect very low birth weight male infants against motor disability at a corrected age of 7 months. Cord blood is a rich source of stem cells, which seem to be critical in normal development of the central nervous, respiratory, cardiovascular, haematological, immunological and endocrine systems.

Is delayed cord clamping harmful?

None of the randomised controlled trials published since 1980 support a link between DCC and symptomatic polycythaemia or hyperbilirubinemia.

Nevertheless,the proportion of infants that require phototherapy for jaundice is increased with DCC compared to immediate cord clamping. Therefore phototherapy should be available.

NICE recommendations

NICE recommends that healthcare professionals do not clamp the cord earlier than 1 minute from the birth unless there is a concern, such as about cord integrity or the baby’s heartbeat is below 60 beats per minute and is not increasing.

The cord should be clamped between 1 and 5 minutes after birth followed by controlled cord traction, which should not normally be attempted until there are signs of separation of the placenta if an oxytocic has been administered.

Umbilical cord milking

During umbilical cord milking, a healthcare professional grasps the unclamped umbilical cord and pushes the blood several times toward the infant over, for example, about 20 seconds.

Umbilical cord milking may improve blood volume more effectively than DCC in premature infants who are delivered by caesarean section. Further studies are needed to identify fully the place of umbilical cord milking in practice.

Impact on Breastfeeding

DCC seems to facilitate breastfeeding, partly by countering the cognitive and physiological consequences of hypovolaemia. Placing the baby immediately on the mother’s abdomen during the delay to cord clamping promotes skin-to-skin contact, which enhances mother-baby bonding, helps regulate neonatal temperature and heart rate, and encourages breast feeding.

Is DCC available in Hong Kong?

Yes! In the public sector DCC is becoming more widely available and in some hospitals is heading toward standard practice. In the private sector availability is dependent on your doctor’s preference. This is something that should be discussed beforehand and expressed in your birth plan.

Cord milking is a somewhat new concept to Hong Kong, but with the childbearing community increasingly demanding this practice, it is likely to gain popularity and therefore benefit future generations.

The Annerley team

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.

References

Hutchon DJR. Immediate or early cord clamping vs delayed clamping. Journal of Obstetrics & Gynaecology 2012;32:724-9.

World Health Organisation. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva: World

Health Organization; 2014.

Leslie MS. Perspectives on Implementing Delayed Cord Clamping. Nursing for Women’s Health 2015;19:164-76.

NICE. Intrapartum care: care of healthy women and their babies during childbirth December 2014

https://www.nice.org.uk/guidance/CG190/chapter/1-Recommendations#third-stage-of-labour Accessed July 2015.

Katheria AC, Truong G, Cousins L, et al. Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants. Pediatrics 2015;136:61-9.

Amitay EL, Keinan-Boker L. Breastfeeding and childhood leukemia incidence: A meta-analysis and systematic review. JAMA Pediatrics 2015;169:e151025.

McDonald SJ, Middleton P, Dowswell T, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane

Database of Systematic Reviews 2013;7:CD004074.

Weeks AD, Watt P, Yoxall CW, et al. Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial

Cardiorespiratory Support (BASICS) trolley. BMJ Innovations 2015;1:53-8.

Uwins C, Hutchon D. Delayed umbilical cord clamping after childbirth: potential benefi ts to baby’s health. Pediatric Health, Medicine and Therapeutics

2014;5:161-71.

Pelaez-Nogueras M, Gewirtz J, Field T, et al. Infants’ preference for touch stimulation in face-to-face interactions. Journal of Applied Developmental

Psychology 1996;17:199–213.

Lagercrantz H, Changeux J-P. The emergence of human consciousness: From fetal to neonatal life. Pediatric Research 2009;65:255–60.

Hood B. The Domesticated Brain Pelican. 2014.

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