The Modern Midwife's Guide to Pregnancy, Birth and Beyond

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Some reviewers found the jovial writing style a little patronising, as it does assume very minimal knowledge about pregnancy So far he has written and published; 'Heart to Heart Parenting', 'Parenting for a Peaceful World', and a chapter in a book called 'Social Ecology, Applying Ecological Understanding to our Lives and our Planet'.

Active Birthing Classes – A weekly antenatal class for expectant mums to help you enjoy pregnancy, stay mobile, learn about your changing baby and body and prepare for a confident birth. This includes pregnancy yoga, elements of hypnobirthing, breathing techniques for each stage of labour as well as lovely relaxations at the end of each class!Many parents feel that while most practical and emotional support is available from family and friends, learning with other expectant parents is highly valued. Evidence suggests that parents need help to make sense of the emotional as well as the physical changes, the recognition of new responsibilities and implications for their relationships. This is particularly true when this is their first pregnancy. Straight to the point, factual and science-based. It goes into detail about exactly what is happening in your body and why, without being patronising or dumbing things down for the reader.” (Reviewed by Mumsnet user Turtleturtle81) Our verdict Breastfeeding for the first time can be incredibly daunting. Whether you’re worrying about feeding positions, the quality of your baby's latch, engorgement or simply if your baby is getting enough milk, establishing a breastfeeding routine can be really overwhelming, particularly when met with well-meaning but conflicting advice from friends and family.

Additionally, hyperemesis gravidarum, carpal tunnel syndrome and fatigue can be particularly challenging for those pregnant with hEDS/HSD ( Pezaro et al, 2020). In one case study, bladder diverticulum has reportedly developed without any obstruction of the urinary bladder during pregnancy ( Pradhan et al, 2020). This may be because of the growing fetus pressing over the bladder where connective tissues may be compromised. Consequently, in such instances, herniation and diverticulum can formulate and increase as the pregnancy progresses. Such cases may be managed conservatively unless chronic symptoms and complications arise in which case surgery may be required ( Pradhan et al, 2020). In one study of 13 881 592 births occurring in the US, women with EDS were found to stay longer than seven days in the hospital setting following the birth of their babies (OR 3.10 (95% CI 2.34-4.09)) ( Nicholls-Dempsey et al, 2019). Similar data has also associated EDS with increased maternal mortality in the US (OR 9.04 (95% CI 1.27-64.27)) ( Spiegel et al, 2020). The authors of these works suggest that such findings certify EDS in pregnancy as a high-risk condition. However, because the findings did not distinguish which of the 14 subtypes of EDS this included, caution should be taken. This is because people with vascular EDS would endure a high-risk pregnancy as opposed to the risks associated with pregnancy and hEDS/HSD, which should be determined in relation to individual symptoms. Findings in relation to other geographical areas outside of the US remain absent, and one must consider the fact that despite spending more on childbirth than any other country in the world, the US already has worse outcomes in maternity services than any other high-resource countries ( National Academies of Sciences et al, 2020). Accordingly, further evidence in relation to outcomes, best practice in postnatal care and length of hospital stay for those with hEDS/HSD is required, especially as some with hEDS/HSD can experience an uncomplicated postnatal recovery ( Pezaro et al, 2020). Neonatal care considerations In relation to the management of poor wound healing and anaesthetic coverage along with the additional risk of wound dehiscence in the postnatal period, our previous care considerations advocated the use of non-tension, non-dissolvable, deep double sutures, left in for at least 14 days in line with Chetty and Norton (2017), and individualised assessments of pain ( Pezaro et al, 2018). Frequent joint dislocations, along with difficulties in holding, caring for, bonding with, and breastfeeding can also further complicate parenthood for those with hEDS/HSD ( Pezaro et al, 2020). People with hEDS/HSD are at a greater risk of experiencing shoulder symptoms, which early findings indicate may be improved with strengthening exercises ( Liaghat et al, 2020). As such, there may be a heightened need to provide more bespoke, and practical postnatal care for those recovering from birth and engaged in early parenting with hEDS/HSD. The functional state of the autonomic nervous system plays an important role throughout pregnancy, childbirth and in the newborn condition ( Atallah et al, 1999; Egliston et al, 2007; Dmitrieva et al, 2011). Postural orthostatic tachycardia syndrome (POTS) is a form of autonomic dysfunction that can cause orthostatic intolerance, with up to 78% of women with hEDS/HSD potentially affected ( Gazit et al, 2003). Significantly, in one study of pregnant women diagnosed with autonomic dysfunction, where autonomic dysfunction was present in 55% before pregnancy, this figure rose to 100% during pregnancy ( Taitubayeva et al, 2020). Those with POTS may also experience symptoms such as trouble concentrating, light-headedness, palpitations, fatigue, exercise intolerance, and in severe cases, syncope (fainting) ( Fedorowski et al, 2021). The authors of a recent review of the literature have determined that there is inadequate published evidence to confirm any relationship between hEDS, POTS and mast cell activation syndrome ( Kohn and Chang, 2019). However, others have argued that the overlapping symptoms of these conditions and their under-diagnosis means that the potential link should not be ignored, as clinical experts find these three conditions together commonly in practice ( Roma et al, 2018; Afrin et al, 2020). Such academic debates highlight the need for further inquiry. In due-date based groups, our registered midwives guide you through up-to date evidence based information and provide pragmatic tips in a relaxed and open minded environment.This interview is full of deep explorations around relationship; with self, with cycles, and with those who teach us. Enjoy !

Strategies that promote spontaneous pushing in favour of directed pushing for those with POTS are recommended ( Pezaro et al, 2018). Though for this group, decision making in relation to labour and mode of birth should be based on obstetrical considerations, rather than simply a diagnosis of POTS ( Morgan et al, 2018; Ruzieh and Grubb, 2018). Nevertheless, frequent monitoring of hemodynamic parameters may be advisable during the second stage of labour, as pushing, pain and fluid loss may result in a worsening of symptoms ( Ruzieh and Grubb, 2018). It may also be useful to consider the administration of early analgesia for those with POTS to reduce tachycardia and associated complications ( Morgan et al, 2018). To this effect, birthing environments that promote calm and relaxation will also be highly valuable. Postnatal care considerations

The management of hEDS/HSD in childbearing remains complex. Yet, considering the new approximate figure of 1 in 20 put forward for the proportion of pregnancies affected by hEDS/HSD, cases in maternity services should no longer be considered rare, only rarely diagnosed ( Pezaro et al, 2020). It is considered that the recognition of hEDS/HSD is now critical ( Tinkle, 2021). Though as outlined in our previous review, the role of the midwife in this context is not necessarily to diagnose cases of hEDS/HSD but to work in partnership with those affected as part of a multidisciplinary team in making evidenced-based care plans along with early and appropriate referrals ( Pezaro et al, 2018). Nevertheless, it may be useful for midwives to remain informed and alert to the possibility of many pregnancies occurring in people affected by hEDS/HSD who are as yet undiagnosed.

Please note at present we are no longer running low dependency information evenings. Obstetric physiotherapist classes The symptoms of pregnancy can be exacerbated by hEDS/HSD and vice versa ( Pezaro et al, 2020). Those pregnant with hEDS/HSD can experience disabling increases in joint laxity along with a variety of urogynaecological complications ( Gilliam et al, 2020). Pelvic pain and joint instability are common ( Lind and Wallenburg, 2002; Volkov et al, 2018; Ali et al, 2020) and pelvic girdle pain can be especially notable in the first trimester of pregnancy ( Ahlqvist et al, 2020). In our previous review, we promoted the need for early referrals to physiotherapy services and general practitioners in such cases ( Pezaro et al, 2018). Due to increased elasticity in the soft tissues of those with hEDS/HSD combined with increased levels of relaxin during pregnancy, our previous review also highlighted that the occurrence and severity of varicose veins and/or gastrointestinal reflux may be increased ( Pezaro et al, 2018). Such cases of problematic varicose veins may be managed with the use of compression hosiery and/or a referral to a vascular service ( Marsden et al, 2013). Increased gastroesophageal reflux may be managed via standard treatments. For those with hEDS/HSD, joint hypermobility and instability are generally best managed conservatively with the use of physical therapies, orthotics and avoidance ( Tinkle, 2021). Navigating through your baby's first year can be full of highs and lows, including challenges such as postpartum recovery and sleep deprivation. At times, it can be hard to trust your instincts, particularly when you are constantly met with others' opinions or recommendations of the ‘best’ way to approach parenthood.Bears of Hope – Bears Of Hope Pregnancy & Infant Loss Support provides leading support and exceptional care for families who experience the loss of their baby. Bears of Hope has a great Facebook group for grieving parents. There is also one group set up just for Dads. http://www.bearsofhope.org.au/