Baby and You - Your Guide to Babies, Family Issues and Being a Parent

Ask The Expert

ABOUT OUR EXPERT

Vicky Carne, MSc; BA (Hons); ADM; RM; RN

Vicky trained as a general nurse and then a midwife in the early 1980s and spent 16 years working in a large maternity unit in Bristol. During this time, she gained experience in all aspects of midwifery care as well as; management, practice development and the statutory supervision of midwives.

Vicky also gained an Advanced Diploma in Midwifery and a Bachelor's degree in Health Studies. She left the NHS in 2001 to take up her current post as MIDIRS Head of Midwifery and her main role is as 'lead' for Informed Choice. Vicky has also led on a number of collaborative projects, including the development of a resource for midwives involved in the care and support of pregnant teenagers and young parents. She completed a Master¹s degree in Public Health in 2005.

Vicky's particular midwifery interests are breastfeeding, evidence-based practice and information development. She lives in the countryside with her two children, her partner Chris, and their four corgis.

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Dear Mum Plus One, My 9 month old is lactose intolerant but also has a very sensitive tummy and she also suffers from reflux. I am struggling with weaning, especially snacks during the day as I have realised that fruit upsets her stomach. Please could you suggest alternative snacks?

Weaning your child can be an anxious and a fun time for most parents as you start to introduce your baby to new foods, tastes and textures, and your child begins to learn how to handle and chew their food. As with many other aspects of child care, it is important to take things at your daughter’s pace - be patient and don’t rush her meal times - and keep persevering. Coping with a baby who also suffers from reflux can bring added challenges, so ensure that your daughter is seated, well-supported and upright when eating and try offering her smaller portions more regularly throughout the day, rather than three larger main meals. When your daughter is showing you that she has had enough food or is refusing to eat, call it a day and wait until the next mealtime. Weaning and dealing with potential food intolerance are aspects of baby development, care and advice that come under the specific expertise of health visitors and GPs. It is unclear from your enquiry whether your baby has been medically/definitively diagnosed with reflux and lactose intolerance; if this is the case then those who diagnosed your baby are the best people to get advice from regarding her current difficulties. If this is not possible then I would suggest that you contact your health visitor or GP in the first instance and ask their advice. They will be able to suggest different foods or might advise referral to a dietician or other specialist to help support you with your daughter’s dietary intake. This means that your baby will continue to receive the important vitamins, minerals and nutrients that she needs for her growth and development, while still being able to try new food groups and avoiding those that may cause her tummy to become upset.Additional information and advice on baby weaning is available from NHS Choices at: http://www.nhs.uk/conditions/Babies-weaning/Pages/Introduction.aspxAlso, Birth to Five - Healthy diet: weaning and beyond at: http://www.nhs.uk/Planners/birthtofive/Pages/Healthydietweaninghub.aspxBest regardsVicky

Dear Mum Plus One, I had a baby seven weeks ago and I am still bleeding. I’m getting quite worried – is this normal?

The blood loss (lochia) that every woman experiences following her baby’s birth is where the lining of the uterus (womb) is shed once the pregnancy has come to an end. Research now shows us that the amount of bleeding and length of time taken for this bleeding to stop can vary significantly from one woman to the next. It is difficult to ascertain from your question whether the bleeding that you are continuing to experience is fresh (ie red), or is a brown or more of a pink colour? Also the extent of the bleeding – is it heavy, moderate or minimal, or has it increased more recently? One of the most important indicators is how you are actually feeling in yourself – do you have any lower abdominal tenderness, or discomfort, do you feel ‘fluey’, which can sometimes indicate that you have a raised temperature and may have an infection brewing? Also, does the blood on your sanitary pad smell offensive? Blood normally has a distinctive heavy, metallic odour, but where an infection has developed, the lochia often becomes very smelly and may also increase in volume. If you notice an unpleasant odour and have found that you need to change your sanitary pads more frequently, and/or are feeling under the weather, make an appointment to see your GP. They will be able to examine your abdomen to make sure that your uterus is returning to its pre-pregnancy size and may also suggest taking a vaginal swab to check for the possible presence of infection. If it is found that treatment with antibiotics is needed they will be able to arrange this for you also. Vaginal bleeding can also indicate that menstruation (your periods) has restarted; this is particularly the case where your baby is being formula fed, as breastfeeding and the hormones needed to maintain your milk supply delays menstruation. Sometimes, blood loss post birth and the return of menstruation happen close together and it can be difficult to identify your body’s return to its normal menstrual cycle. It is important to remember that where women are not fully breastfeeding, they can become pregnant 21 days after their baby’s birth, which is usually the time when ovulation resumes. It is always better to err on the side of caution, so my advice is to see your GP and get yourself checked over. Your GP will be able to give you reassurance and ensure that all is as it should be.Best wishesVicky

Dear Mum Plus One,

I gave birth several months ago. I had an awful time due to many things, the worst things were the horrible midwife and doctor, I won't bore you with the details. I still have nightmares and flashbacks, and was diagnosed with PTSD.

I had a forceps delivery, during which a midwife held my shoulders down and one held my hips down and I was physically dragged down the bed by the forceps. Is this normal or was the force used excessive? The forceps were across my baby's face. He developed jaundice wouldn't feed and was tube fed. He has been an unsettled and miserable baby - are they all connected?

I am so very sorry to hear that the experience of giving birth to your baby has left you feeling traumatised. The majority of new mums experience overwhelming feelings of joy and elation following their babies’ births; however, your memories are still clearly raw and traumatic for you. It is rather difficult for me to respond to your query as I don’t have a full picture of the events surrounding your baby’s birth; however, I hope that the following might be of some help.

Midwives and doctors have a professional duty to explain to the women in their care why they are recommending a particular care option or treatment; equally, they have a responsibility to ensure that women receive sufficient and appropriate information that they are able to understand and with which they can make informed choices and decisions. This is something that every midwife and doctor should be committed to; however, there can be some occasions when this can be difficult. The time when this is most likely to occur is where a woman is in labour and her baby is not coping with the labour contractions. This is referred to as ‘fetal distress’ and there can be very serious concerns about the baby’s health and well-being, necessitating their delivery without delay. This might mean the obstetrician recommends immediate delivery of the baby by emergency caesarean section, or would advise that the baby’s birth is assisted using forceps or the ventouse (vacuum extraction). Ensuring that women in labour are able to understand what is being recommended, what is involved, and the reasons for advising this care or course of action can be difficult, particularly in urgent/emergency situations. Also where women are in a lot of pain and/or distressed and/or have received medication for pain relief, such as pethidine and/or Entonox, this can make it more difficult for them to understand the information that they are being given. While the use of pain relieving drugs and Entonox are common in labour, they do have side effects and can make women feel very drowsy, disorientated and ‘distanced’ from the events happening around them. They can also impair a woman’s perception and recollection of the events around her labour and baby’s birth.

So, while the doctors and midwives are very familiar with these situations, this is not the case for the woman in labour who can be very traumatised by these events and the extent of this trauma can lead to the condition Post Traumatic Stress Disorder (PTSD), as you appear to be experiencing. What is quite important is to realise that the action taken by the doctors and midwives may be appropriate, but it is also the case that on some occasions it may not be. For you, one way to both try to help reduce the effect of the PTSD and to establish whether there was any wrongdoing on the part of the doctors and midwives is to look at the records that were made while you were in labour. If you are under the care of a GP or a psychologist for your PTSD, you might want to check out the following information with them before you proceed.

A good starting point in seeking the answers to some of your questions would be to contact the maternity unit and arrange to meet with one of their supervisor of midwives. Supervisor of midwives are experienced midwives who are appointed by the Local Supervising Authority and so can offer women independent guidance and support. This meeting could take place either in your own home or at the maternity unit and would be a good opportunity to discuss your experiences and their effects on your emotional well-being since your baby’s birth. The supervisor of midwives will be able to listen to you, answer any questions that you might have, and can also explain the medical terms used. You can ask to see your health care records; usually this is through the medical records department of the Trust, who will charge a small fee. It might be helpful to have these with you when you meet the supervisor of midwives. The records will contain information about the care that you received during your labour and birth. The practitioners who gave you that care, the observations they made throughout your labour and the events surrounding your baby’s birth, should have all been recorded in your labour record; this is in the form of a chart called the partogram. Other notes might be made by doctors on separate pages, but the records should be clear and readable, and the supervisor of midwives will be able to explain any terminology that is unfamiliar. The supervisor of midwives will also help put the care that you were given into context, and having this explanation might resolve some of the traumatic memories you are currently re-living.
As regards the actual birth itself, it is very difficult for me to respond to your question as I was not present at your baby’s birth. The only comments that I can make are as follows.

Where a woman is highly distressed during an assisted (forceps) birth and there is a real danger that she might fall off the delivery bed and injure herself or her baby, I am aware of the occasional situation where a midwife has needed to support the woman to prevent this from happening. This should, however, not involve holding down or restraining any part of the woman’s body. Similarly, when a doctor is applying forceps to a baby’s head or is asking the woman to push during each contraction while delivering her baby; I am aware of rare situations where the woman has been advised to try and keep her bottom on the bed. This helps to ensure there is no unnecessary trauma to the baby or the woman’s perineum. Again, this should not involve holding down or restraining the woman’s movement. However, if you feel that you were actually physically restrained, I would advise that you explain how you feel to the supervisor of midwives.

Regarding the forceps marks on your baby’s face, even though the doctor would have taken great care while applying the forceps around your baby’s head, these are sometimes unavoidable. When the baby’s head is in the most common position, this means that when the forceps are applied, they are positioned on each side of the baby’s head, avoiding the baby’s face. If the head is not in this position, this is often a reason why labour has not progressed and why the baby has not descended down the birth canal as far as it should. This also means that sometimes when the doctor applies the forceps it is unavoidable that they will be positioned over some part of the baby’s face. The bruising the forceps can cause may also exacerbate the naturally occurring jaundice that every newborn baby develops around the third day following their birth. Where a baby’s jaundice is more severe, the baby can become quite sleepy and reluctant to feed: babies born with forceps can also sometimes have a bit of a headache and may be a little more irritable and unsettled for a short time after their birth. However, this should resolve within 24 hours without any lasting ill effects. All of the events around the labour that have affected you will also have had some effect on your baby. Babies are sensitive individuals with their own little characters; this sensitivity means that they can easily pick-up on the emotions of their carers. It can sometimes take several weeks, or even months for babies to settle, sleep and eat within a regular pattern. Very occasionally, babies can have longer-term effects from a forceps delivery, and sometimes a special therapist called a craniosacral osteopath who specialises in paediatrics (babies and children) can be helpful. For more information on this visit: www.craniosacral.co.uk (The Cranial Sacral Association).

If you have not already sought support from your health visitor or GP in relation to these specific feelings, maybe you should consider sharing your experiences with them, as well as with your partner, your family and close friends. All of these people should be able to offer you support and may help you to make progress and resolve the issues around your baby’s birth so that you can look forward more positively to life together as a family.

Every best wish

Vicky

Dear Mum Plus One,My six week old son has jittery legs during urination, and at other times too. Why does he have it? He was born by caesarean section and had ingested a lot of fluid during labour. Please help.

I have a six month old daughter and would like to try for another this year but have recently read that you should wait two years if you had the previous baby by Caesarean, which I did. Is this correct?

Firstly, many congratulations on the birth of your baby daughter!

As you may be aware, caesarean section (C/S) is the most common major operation performed on women worldwide, with women being over four times more likely to have a caesarean birth now than they were thirty years ago. The concern about the high number of caesarean births means that healthcare professionals and the maternity services are trying to ensure that caesarean sections are only performed when necessary. Women who have undergone a C/S are more likely to have their next baby by C/S, and an additional concern is that the risks associated with having a caesarean increase with the number of caesareans a woman has undergone.

While your query is an extremely common topic for discussion on various mother and baby forums, there is actually very little evidence-based information available about the timeframe for when you should start trying for another baby. However, the available information suggests that it is best to wait for a period of between 1-2 years. This is because when you’ve had a caesarean birth, your body needs to recover from a major surgical procedure as well as the effects of pregnancy. Your uterus will need time to heal after the surgery as will your abdominal muscles and the wound site. It is therefore advisable to allow your body the time it needs to recover sufficiently from your last pregnancy and your daughter’s birth, and give your muscles time to strengthen. The consensus expressed by obstetrician colleagues is that, when they are asked this question by women, they advise them to wait one year before embarking on a subsequent pregnancy.

The reason for why your baby was born by caesarean section can make a difference to overall advice on the next pregnancy. Therefore, if it was a planned caesarean, or was undertaken as an emergency, there might be factors that could affect the advice given. Your GP would be able to discuss this with you and give you advice on an individual basis. The local maternity unit might also be able to give you information about what they currently advise. For additional information also visit: www.choicesforbirth.org and look at MIDIRS Informed Choice leaflet Caesarean section and subsequent births.