In Dissertation Hell

My dissertation is a clinical dilemma. However in practice I am wracked by clinical dilemmas. Here are a few I am currently mulling over

Why do we ARM?

Why do we promote normal birth in every respect save for third stage of labour where we routinely interfere?

How do we promote skin to skin following birth when we are drying and wrappping the baby to maintain thermoregulation?

Why do so many women go home from hospital breastfeeding then give up so soon after going home?

Why do we routinely give ranitidene on my unit to every woman in labour when my unit has a 13% caearean section rate


I need to choose a dilemma to write about.

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Gillian

Third Year Student Midwife

Loads of great areas! i'd probably chose the BFing one. I'm obsessed with it. I'd say it's down to fequency of CM visits and lack of expertise too. The whole BFing thing needs re-addressing.

I've had 3 CMs on my placement so far, and only one of them had actively gone out of their way once to return to a mother struggling. Visits are on day (depending on discharge from hosp, birth is classed as day 0 btw) 1, 2, 5 and 9/10 for discharge. And as milk comes in on day 3,4,5 ish, so there is a huge chuck of time where BFing is left to the mother without support, at the most crucial time. PLus one CM didn't know what to say when parents asked if they could BF past teeth emerging. She simply did not know. The BFing expertise and support is shocking and i find very upsetting and frustrating. Maybe it's about further and ongoing mandatory training for MWs? I dunno. None of them actually showed any mothers how to hold the baby to avoid sore nipples, they jsut left it to 'maternal choice'. It's almost like the MWs wait until a problem emerges and until then they practice the same non-interventionist stance that is promoted in pregnancy and birth on the whole. But BF is not instinctual, it's a skill that needs 'hands-on' practical support more than is offered, IME. Rant over!

Are these areas you have been given or have come up with yourself? I heard about the dilemma associated with routine of early cord cutting, depriving the baby of placental nutrients including oxygen, particularly important for prems. The dillemma being that prems particularly need to be attended to very soon after birth, but leaving the placenta attached to baby for just an extra 20 seconds may have important irreplacable health benefits.

Just an idea! Good luck with it!

Can I add a point about the breastfeeding issue.

I gave up as soon as I got home with my middle son as I just didn't know what to do. Didn't get any help in the hospital and I did ask.

With my daughter I gave up on day 3 as I had really sore nipples and again I didn't know what to do but because she was was 3rd baby the midwife hardly came to see me at home.

As I had my first at 16 I didn't attempt to breastfeed. It wasn't encouraged enough either.

Anyway sorry for going off on a tangent to the original post. Can't help with dissertation advice as I don't even know what one is!!!

Heidi

Hey I'm doing my diss' on the timing of clamping/cutting the cord, now I leave it pulsating at del' then give syntometrin after 2 mins, it helps the placenta do its bit aswell so 3rd stage seems better to me x

Thats really interesting Tracy. Can I ask what evidence are you basing your practice on?

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Gillian

Third Year Student Midwife

Great ideas!

I wan't to do the use of ARM for mine. i found loads of research so if you need anything let me know!

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yeah read the stuff by Mercer and Skovgaard, she's done lots on it and any of the paediatric journal now agree to leave the cord pulsating and you shouldn't give syntometrin with anterior shoulder (you couldn't in our trust as your alone at del!) as the neonate can end up with polycythaemia -due to the overload of blood after synt has been administered, its a fab topic when you get into it, sometimes the paediatric stuff is a bit heavy though-I'll get there lol x