When new mums need help most

 

New research released today has revealed that, after the understandable flurry in the first eight weeks of motherhood, the period when first-time mums have the most questions about their babies’ development can be pin-pointed to five months and one week[1] after they have given birth.

 

This crucial period is when visits from friends and family naturally decline, leaving mums to make decisions on their own, and at risk of feeling isolated and anxious.

 

Mums had the most new questions at this time around weaning (81%), sleeping (42%) and safety in the home (22%).  The survey was undertaken to help with the development of NHS Baby LifeCheck by the Department of Health. NHS Baby LifeCheck (www.nhs.uk/babylifecheck) is a free online questionnaire to help new mums and dads keep their babies healthy, happy and safe.

 

The research found that during the five to eight month period:

 

• 81% say their baby’s needs are changing and developing quickly (teething, weaning, moving around) which leads to lots of questions and concerns as to whether they’re doing things right and meeting all of those needs.
• 60% experience a drop in regular visits from friends and family.
• 54% say their partner is less able by this point to get home or be at home to help out.
• 32% say they don’t have any time for themselves.
• 20% felt the realisation that baby care tasks are ‘repetitive and mundane’.

 

However, advice and support is available at this time from child health clinics, general practice and Sure Start Children’s Centres.

 

Kayleigh Pillington, a new first time mum of Logan-Rhys, now six months, says:

 

“Everyone is so excited about the baby at first, but five months in when you’ve got more questions than ever because they’re doing all these new things, interest in you and the baby really dies down. That’s when I started to feel anxious – it was all on my shoulders and I just wasn’t sure if I was doing it right.”

 

More than half (54%) of new mums hear from family once a week after their baby is born, but this drops to only a quarter (25%) five months in.

 

While grandparents, aunts and uncles may offer to help with babysitting and bedtime up to three or four times a week (65%) in the first month post birth, by five to eight months they only offer once a week or less (63%).

 

Public Health Minister Gillian Merron said:

 

“This is about equipping first time parents to make the best choices for their babies. The Government recognises that being a new parent can be a worrying time, and you want reassurance that what you’re doing is right. Parents are looking for a source of reliable information to get this reassurance and to know that they are doing the best they can for their child. That’s why the Government has set up the NHS Baby LifeCheck to empower parents to make confident decisions about their baby’s health, happiness and safety.”

 

Nicola Stenning, a Health Visitor from London said: “Parents are given essential support and advice in the first few months of their baby’s life. But the next stage is also a key time in their child’s development and can be a difficult time especially for first time parents.  It is important that information and advice is easily accessible, which is why NHS Baby LifeCheck was developed.

 

“It particularly focuses on providing support for parents of five to eight month old babies between scheduled visits from health professionals and it is a key time in their development. By guiding parents through some simple questions, we can then offer advice and reassurance on making the best decisions for their child without being judgemental.”

 

Created in consultation with parents, www.nhs.uk/babylifecheck recognises that being the mum or dad of a young baby can sometimes be a challenge.

 

It is an easy to use, online service covering topics including: development, talking and playing, feeding, healthy teeth, safety, sleep routine, immunisations and being a parent. www.nhs.uk/babylifecheck offers top tips, helpful videos and details of organisations which can support people across a range of issues – from weaning worries to feeling down or lonely.

 

Notes:

 

[1] Between 3 and 12 months of a baby’s life, mums are on average most likely to feel anxious and isolated at 5.2 months

 

Opinion Matters research carried out of 510 mothers with a child aged five to 12 months old between 24/09/2009 and 02/10/2009.

 

• NHS Baby LifeCheck is not a medical assessment and has no symptom checker. It does not provide help for parents who are worried their baby is ill. Parents with medical concerns should call NHS Direct.

 

• In the public consultation “Your Health, Your Care, Your Say” people clearly expressed an interest in taking more responsibility for their health and wellbeing. Three quarters of participants identified regular health checks as a top priority to help them do this.

 

• In response, the 2006 Government White Paper ‘Our Health, Our Care, Our Say’ announced the development of three initial NHS LifeChecks:

 

- one for young people aged 12 – 15
- one for parents and carers with babies five – eight months old and
- one for the 45 – 60 years age group 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New guide to improve neonatal care

 

The Department of Health is today publishing new guidance to help the NHS improve the care provided for premature and sick babies during their first days.

 

The NHS has made great progress in caring for babies with the lowest infant mortality rates and NHS neonatal services now care for over 60,000 babies a year.

Babies who are born prematurely, or have a low birth weight, require very specialised care in their first hours and days.  A Neonatal Taskforce was established to identify ways of further improving services to offer the best neonatal care possible.  Experts from baby charity Bliss and specialist NHS staff have helped to develop the Neonatal Toolkit to share its findings and guidance with the NHS.

While England remains one of the safest places in the world to give birth, the Taskforce has recommended that neonatal care become more family-centred to ensure the psychological as well as physical needs of babies and families are considered.  The Toolkit they have created provides practical advice on how to improve the areas that really matter to parents including:

*       making sure the right staff are on hand at the birth

*      managing high-risk pregnancies to make sure babies are born in the best place

*       improving transfers between services where necessary

 Health Minister Ann Keen said:

“As a nurse I’ve seen the excellent care the NHS provides for small and premature babies, and the doctors and nurses working in neonatal care should be proud that more babies than ever before are surviving.

“Having a sick baby is very distressing for parents at what should be one of their happiest moments.  That’s why we’re providing the NHS with practical guidance on how to make neonatal services even better and take a family-centred approach to care.  To ensure this Toolkit makes a real difference to neonatal care I have also asked to have ministerial oversight of its implementation.”

Neonatal services have been boosted in recent years with the establishment of neonatal networks.  The networks ensure joined-up care in each area and have helped to increase the number of neonatal beds and staff across England.  The Neonatal Taskforce was established last year to identify and deliver further improvements to services.  The Taskforce will continue to support the NHS to introduce the recommendations made in the Toolkit and ensure it has a significant impact on neonatal care.

 

 

 

‘Character’ is the key to social mobility

 

‘Tough love’ parents who combine warmth and discipline are better at building good character capabilities in their children ,finds a major new report from the think tank Demos.

 

Character capabilities – application, self-regulation and empathy – make a vital contribution to life chances, mobility and opportunity. For those who turned 30 in 1988, character capabilities barely impacted on their economic success. But in just over a decade, these skills became central to life chances: for those who turned 30 in 2000, character capabilities had become 33 times more important in determining earnings.

 

The development of these character capabilities is profoundly shaped by the experience of a child in the pre-school years. Children with ‘tough love’ parents were twice as likely to develop good character capabilities by age 5 as children with ‘disengaged’ parents, and did significantly better than children with ‘laissez faire’ or ‘authoritarian’ parents.  The Building Character report, which analysed longitudinal data from over 9,000 households in the UK, found that eight per cent of families have parents that are ‘disengaged’, which is approximately 600,000 families.

 

Parental confidence is also vital to developing character capabilities.  Children of parents who rank themselves poorly in terms of their own parenting ability are less likely to develop key character skills.

 

Building Character looked at the effect the following factors had on infant character development:

 

Income

• Children from the richest income quintile are more than twice as likely to develop strong character capabilities than children from the poorest quintile. 

• Children from the poorest income quintile are three times less likely to develop strong character capabilities than children from the richest quintile.

• While ‘tough love’ parenting is less frequent in low-income backgrounds, the ‘love’ element was consistently distributed throughout economic groups. Consistent rule-setting and authoritative parenting was associated with wealthier families, indicating a need for parents to set more consistent discipline and boundaries in lower income groups.

• When parental style and confidence are factored in, the difference in child character development between richer and poorer families disappears, showing that parenting is the most important factor influencing character development.

 

Family structure

• Children with married parents, both of whom are a biological parent, are twice as likely to develop good character capabilities than children from lone parent or step-parented families.

• Children with cohabiting parents fair slightly worse than those with married parents, but better than those with lone parents or step-parents.

• When parental style and confidence is factored in, the relationship between family structure and child character development disappears almost entirely, showing that parenting is the most important factor influencing character development.

 

Other factors

• The primary carer’s level of education has a positive effect on developing character capabilities.

• Breast-feeding to six months has a positive effect on developing character capabilities.

• Girls are more likely to develop character capabilities by the age of five.

• There is no connection between paid employment on behalf of either parent and the development of character capabilities.

 

The report found that while there are links between income and family structure, and the development of character, parental ability significantly diminishes these factors, making parental style and confidence the most important tools in improving social mobility.

Based on the research conducted for this report, the goals for policy should be to:

• Strengthen provision of support and information to parents to help them incubate character capabilities in their children.

• Focus support on disadvantaged children – those with ‘disengaged’ parents and those from low income groups – which have greater susceptibility to the quality of their care and poorly performing parents.

• Ensure quality control and value for money in early years intervention.

 

An ambitious agenda for equality of opportunity will need to take the development of character capabilities seriously.  Building Character includes the following policy recommendations:

 

Refocus Sure Start as a tool for early intervention: Sure Start should be less focused on childcare and more focused on child development, particularly parent-child interaction. Sure Start could also act as a more effective hub for creating peer relationships and local networks that can be central to parental support.

 

Improve pilots for the Family Nurse Partnership: While a promising model to follow from the US, before the pilots are rolled out nationally, there must be more evidence for how a FNP should work in a UK context.

 

Give health visitors an early years role: More emphasis should be placed on health visitors’ role in identifying and supporting positive parenting. Health visitors should carry out a ‘Half-Birthday Check-up’ to monitor progress and identify families that need extra support.

 

Set up a ‘NICE’ for evidence-based parenting interventions: A national body to ‘kitemark’ successful, evidence-based parenting programmes would aid local commissioners to invest in programmes that are proven to work.

Jen Lexmond, principle author of the report said:

 

“Character, something we tend to think of as a ‘soft skill’, has the most profound effect on a person’s life.  Far from a ‘soft’ skill, character is integral to our future success and wellbeing.

 

“The foundations for our character are laid before the age of five. This puts a huge emphasis on parenting, but whatever the parental background, it is confidence, warmth and consistent discipline that matter most.”

Notes:

 

Character is identified as:

Application

Application is about sticking with things. It describes one’s ability to concentrate, discipline and motivate oneself to persist with and complete a task. Strong application is underpinned by a sense of self-direction or free will, what psychologists often term agency or ‘locus of control’. It is an executive function, the impetus itself which pushes you to apply yourself to an activity, task or project. Locus of control is understood as a spectrum from an internal locus of control to an external locus of control – the former implying that an individual feels a sense of control over their environment, that they are setting the course for their life, the latter implying an individual’s attitude toward external factors as largely determining his or her life course.

 

Self-regulation

Self-regulation represents an ability to regulate emotion. It is about emotional control and also emotional resiliency – an ability to bounce back from disappointment, conflict and distress. Children who have effective strategies for dealing with these losses are much more likely to overcome adversity than those whose reactions overtake them, push them to overreactions, tantrums or violence. Individuals acting in a social world will respond with propensities (individual traits) to triggers (outward stimuli). Self-regulation determines an individual’s propensity towards overreaction or violence when triggered by an upsetting or conflict-laden situation.

 

Empathy

Empathy is an ability to put yourself in another person’s shoes – and to act in a way that is sensitive to other people’s perspectives. Empathy develops as a direct result of attachment between a child and their primary carer. From birth to age three, the number of synapses (neural connections) in the brain multiplies by 20 – and most are formed as the result of experience in their new environment. Synapse pathways are reinforced by repeated early experience; the effect is that this early learning becomes extremely resistant to change. The more nurturing and responsive an infant’s environment is and the more attuned carers are to the infant’s needs, the stronger the infant’s sense of empathy will become. Empathy leads to pro-social behaviour. It is ultimately a relational capability and underpins a set of social skills that allows individuals to interact and communicate with each other effectively.

Looking at data on over 9,000 families in the Millennium Cohort Study, Demos identified four parenting styles:

 

Tough love

This group of parents combine a warm and responsive approach to child rearing with firm rules and clear boundaries. They are assertive without being aggressive or restrictive and the aim of their disciplinary methods is to reason with and support their child rather than to be punitive. Children from ‘tough loving’ families are characterised as co-operative, self-regulating and socially responsible.

 

Laissez-faire

Highly responsive parents who are undemanding in their approach to discipline and generally non-confrontational make up a second parenting style. They are non-traditional and engaged in their approach, opting for a lenient and democratic household that allows children considerable opportunity to develop at their own pace. Laissez-faire parents are permissive of behaviour and do not impose many rules.

 

Authoritarian

This group’s approach is characterised by firm discipline and rule-based parenting practices but without much regard for children’s feelings or perspective. These parents typically value obedience and structured environments over freedom and exploration.

 

Disengaged (and, at the extreme, neglectful)

These parents are generally hands off in their approach to parenting. They are low in warmth and discipline. Extreme cases, at the lower end of both axes, make up a further group of poor parents whose children are ‘at risk’: a level of disengagement of a small minority of parents that would be considered neglectful. The lack of engagement that characterises this approach can result in the development of what some psychologists call ‘callousness’ in children. ‘Callous’ children grow up lacking a sense of empathy and guilt, and learn to see others in a purely instrumental way. The influence of parent and peer factors on callousness trajectories during adolescence plays a crucial role in the formation of these traits. Most crucial of all are parents’ warmth, affection and responsiveness in caring for their baby in the early years.

The data for this study come from information collected in the first three waves of the Millennium Cohort Study (MCS). The MCS is a large scale, longitudinal survey of children born during the same week in April across the constituent countries of the UK (Wales, Scotland, Northern Ireland and England). Sweep 1 (MCS1) was executed during 2001–02 and included information on 18,819 babies in 18,533 families, which was collected from parents when the babies were between nine and 11 months of age. The design of the sample allowed for over-representation of those families living across England in areas with high deprivation, child poverty or ethnic minorities, as well as the three smaller countries in the UK. The first follow-up study (MCS2) took place when those same children were three years old (between 35 and 39 months of age at interview). The achieved response rate at this wave was 79 per cent of the target sample. The second follow-up study (MCS3) took place when the children were five years old and achieved a response rate of 79.2 per cent of the cohort (15,246 families). Comprehensive information on the individual cohort sweeps – objectives, origins, sampling and content of surveys – as well as documentation attached to the data can be found at the Centre for Longitudinal Studies website.

 

 

 

 

 

 

Premature Births: Death

Commons Written Answers – House of Commons – Health

Mr. Andrew Smith:

To ask the Secretary of State for Health what progress the NHS is making in reducing the number of babies who die following premature birth.

Ann Keen:

Advances in technology and health care expertise have led to increasing survival rates of very premature babies over the last 20 years. Over the past decade, survival has improved dramatically for babies born at 26 weeks of gestation and above so that now over 80 per cent. survive.

The EPICure Study (led by the university of Nottingham, Department of Child Health) was established in 1995 to determine the chances of survival and later health status by following up children who were born in the United Kingdom and Ireland at less than 26 weeks gestational age during a 10-month period in that year. This is now an ongoing study, which it is hoped will not only show survival and rates of disability but also identify factors at birth, which could give an indication as to the long-term outcome for the survivors.

A new study, EPICure 2, covers all babies born in England at 26 weeks of gestation or less during 2006. This study will demonstrate how effective advances in neonatal care have been since the first study in 1995. Preliminary findings, published in May 2008, found that babies born above 24 and 25 weeks of gestation were significantly more likely to survive in 1995 compared with 2006.

Details of the EPICure studies can be found on the EPICure website:

www.epicure.ac.uk

NCT reveals crucial choice guarantee set to be missed by a mile

Over 95% of women in the UK are not able to choose where to give birth, a new report released today by the NCT (National Childbirth Trust) has found. Offering women choice of where to give birth is government policy across the UK as it is proven to have a positive effect on birth outcomes.

The NCT’s report, ‘Location, location, location’ highlights the benefits of choice to parents and calls for governments and health professionals to act quickly to ensure women have these choices available to them.

The ‘Location, location, location’ results show:

95.8% of women do not yet have access to a real choice between the three options of home birth with a midwife, a local midwifery facility (birth centre) either stand-alone or attached to a hospital and an obstetric unit in a hospital (the choices defined in Maternity Matters1)

89% of women live in areas that realistically do not offer the choice of a home birth with a midwife2

With greater encouragement of home birth, choice could be offered to many more women without any significant investment or shift in the way maternity services are structured.3

Over 40% of women live in areas without reasonable access to both a birth centre and an obstetric unit in a hospital

Women are lacking in the information and support needed to make these choices.3

The research for the report was commissioned in light of the Government’s Maternity Matters1 promise that all women in England will have access to choice of place of birth by the end of 2009. NCT wanted to ascertain how many women in the UK actually have access to choice. Scotland, Wales and Northern Ireland have also made similar policies that support the provision of choice for women.

Belinda Phipps, Chief Executive, NCT, says:

“There is a huge task ahead for trusts and boards as many are very behind in implementing this policy. For every ten pregnant women, nine are not able to choose where they want to give birth. We know across the UK, government policies support women with this choice. However, in reality this is not even close to being delivered yet.

“We want the governments to act now. Although in a few cases more investment in maternity services will be needed, with a simple re-thinking of the way their maternity services are delivered every trust and board can ensure choice is available to all women.

We know there are some financial policy obstacles hindering the achievement of choice the NHS could make much faster progress if it corrected these.

“There are a few trusts and boards in the UK that are succeeding in offering women a real choice and these successes are to be celebrated. We now need the rest of the UK to catch up.”

As part of the ‘Location, location, location’ campaign launched today, the NCT is calling for the commitment to guarantee choice of place of birth by the Department of Health to be implemented fully, and for the governments of Scotland, Wales and Northern Ireland to make a similar commitment to guarantee choice.

To achieve this local and national governments will need to:

Review the financial framework surrounding maternity services

Recognise the importance of midwives in reducing costs and delivering choice

Make sure that women are aware of the options and understand that for healthy women with a low-risk pregnancy, all three options are equally safe places to give birth

Ensure all in the maternity services work together and have sufficient training so they are experienced and comfortable in all three settings.

Make sure parents are provided with unbiased information to help them make their choice

Sarah Banks from Derby says:

“The first thing the midwife asked me was ‘which hospital do you want to go to?’  There was no discussion about other options and no mention of the birth centre nearby.  I told her that I wanted to have my baby at home and she refused to discuss it as she said it was too early and wouldn’t be advisable as it was my first baby.”

Both women and maternity services benefit from choice of place of birth being available. For women it leads to better birth outcomes, increased likelihood of straightforward births and improves their satisfaction with the birth. This in turn leads to higher self esteem and can increase parents’ confidence in being able to look after their baby.

For maternity services, offering these choices is likely to lead to reduced costs. Currently most women give birth in an obstetric unit in a hospital which is an expensive option3. With greater choice provided for women, more are likely to give birth in a birth centre or at home with a midwife. Therefore the effort necessary to deliver all three options will be outweighed by the savings made through less women giving birth in hospitals.

Note:

Please follow link to access: Location, Location, Location report

http://www.dodsmonitoring.com/downloads/PlaceofBirthFINALFORWEB%5B1%5D.pdf

Please ofllow link to access: Research report

http://www.dodsmonitoring.com/downloads/Investigation%20into%20choice%20of%20place%20of%20birth.pdf

Location, location, location’ details access to obstetric units, birth centres and home births in the UK and calculates the rate of women of childbearing age in each area with choice. See below for the results of the top and bottom five Trusts.

Local Authorities that offer the least choice

Local Authority	% of women of childbearing age who have choice
Middlesborough	0.0%
Boston	0.0%
Copeland	0.0%
Carlisle	0.0%
Coventry	0.0%

 

Local Authorities that offer the most choice

Local Authorities	% of women of childbearing age who have choice
South Cambridgeshire	100%
Southwark	100%
Cambridge	100%
Derbyshire Dales	91%
Bath and North East Somerset	91%

Norman Lamb: Number of caesareans deeply worrying

Commenting on figures showing that one in four babies in England is delivered by caesarean section, Liberal Democrat Shadow Health Secretary, Norman Lamb said:

“The staggeringly high number of caesarean sections being performed in this country is a serious cause for concern.

“The fact that the rate is nearly double that recommended by the World Health Organisation is deeply worrying, especially given the concerns about the increased risks of the procedure.

“We urgently need to increase the number of midwives in this country so that mothers are given all the advice and support they need during and after pregnancy.”

NHS Maternity Statistics, England: 2008/09

The new NHS maternity statistics for England 2008-9 were released today.

Belinda Phipps, Chief Executive, NCT, says;
“Again we have a release of figures that show the situation for women and babies is getting worse – high caesarean section rates, increased medical interventions, and fewer women giving birth in a place appropriate to them.

“This clearly demonstrates the effect of the lack of progress on Maternity Matters, the governments choice of place of birth promise, which was highlighted in the NCT’s  Location, location, location research report this week. Choice of place of birth leads to better birth outcomes for women, increased likelihood of a straightforward birth and improved satisfaction with the birth. “

Key Points

The caesarean rate has remained the same at 24.6%, with a rise in the numbers of elective caesareans (0.1%) and a decrease in the number of emergency caesareans (0.1%).  This shows a halt in the trend of increasing caesarean rates.
The instrumental delivery rate has increased by 0.1% to 12.2%, with a rise in the forceps rate from 5.0% to 5.5% and a decrease in the use of ventouse of 0.4%.  This continues the trend of increasing instrumental rates.
The induction rate is down 0.2% to 20.2%.  This reverses the recent upward trend.  Since 1999-2000 there had been an overall downward trend, with a low in 2005 but the rate has subsequently risen again.
Normal delivery rates are not available at the moment.  It is hoped the Information Centre will make these available in due course.

68.8% of women had a spontaneous onset of labour, similar to the previous year which was 68.6%.  [Note: this calculation uses a different source for caesarean as method of onset of labour, which is shown as 11%, rather than the 9.8% shown in Table 32, and does not reflect the rise of 0.1% in elective rates over the year]

62.9% of women had a spontaneous delivery, the same as from 2007-08.  This is at an all-time low.

	2006/07	2007/08	2008/09
Caesarean Rate	24.3%	24.6%	24.6%
Elective	9.5%	9.7%	9.8%
Emergency	14.7%	14.9%	14.8%
Instrumental Delivery Rate	11.5%	12.1%	12.2%
Forceps	4.5%	5.0%	5.5%
Ventouse	7.0%	7.0%	6.6%
Induction Rate	20.3%	20.4%	20.2%
Care on GP/Midwife Ward	10.6	11.7	10.8%
Normal Delivery Rate	n/a	n/a

 

Highs and Lows

There are 8 trusts/maternity units with caesarean rates above 30%:

 

Chelsea and Westminster Hospital	33.3%
Imperial College Healthcare NHS Trust (St Mary’s Paddington and Queen Charlotte’s)	33.1%
East Surrey Hospital	30.9%
Barnet Hospital	30.8%
University Hospital, Lewisham	30.6%
University College Hospital, London	30.6%
Royal Sussex County Hospital, Brighton	30.5%
Royal Free Hospital, Hampstead	30.4%

 

There are 5 trusts/maternity units with caesarean rates below 19%.

Kings Mill Hospital, Sutton-in-Ashfield, Notts	15.8%
Royal Shrewsbury Hospital	16.9%
Pontefract Hospital (part of Mid Yorkshire Hospitals NHS Trust)	17.8%
Barnsley Hospital	18.1%
Salford Royal Hospital	18.8%%

Midwife led care

Data for the current years show no increases in births in NHS midwifery facilities – 9.5% in the current year compared to 9.6% in 2007-08.  Care on consultant wards has increased from 44.7% to 48.8%.

Background – Since 1989-90, data have been collected on the place of delivery.  This uses the following categories:

1. NHS consultant ward
2. NHS GP ward
3. NHS combined consultant/GMP/midwife ward
4. NHS midwife ward/other ward or with delivery facilities associated with midwife ward or unit without delivery facilities

These categories are historical and do not necessarily represent current configurations of alongside birth centres, standalone birth centres, midwife led care beds in an obstetric.  Nonetheless, they can indicate changes in patterns of care.

Year	Total deliveries	Total with known place of delivery	Record completeness	Consultant Ward	Consultant / Midwife / GP Ward	GP ward	Midwife ward / Other ward	Total of midwife plus GP led care
2005-06	611,337	360,273	59%	49.4	41.5	1.6	7.4	9.0
2006-07	629,207	378,439	60%	45.9	43.5	2.3	8.3	10.6
2007-08	649,837	305,930	47%	44.7	43.6	2.1	9.6	11.7
2008-09	652,638	495,535	76%	48.8	40.4	1.3	9.5	10.8

 

This shows a decrease in GP/midwife led care in the previous year, and an increase consultant led care. However, record completeness is much higher than in previous years and changes may reflect a more representative sample than in previous years rather than changes in configurations.

Popular pregnancy and parent guides updated

New advice on storing breast milk and the best medicines to take during pregnancy are some of the updates the Department of Health has made to its popular Pregnancy and Birth to Five books being relaunched today.

The books have been a vital source of information for mums-to-be and new parents for over ten years, offering the latest information on issues that matter to them. The books will be given free to all expectant women and new parents by their midwives and health visitors.

The Pregnancy and Birth to Five books have now been updated to reflect latest advice and evidence and include extra information parents have told us they need.  Some of the changes include:

- Increasing the amount of time it is recommended breast milk can be stored in a fridge from 24 hours to 5 days

- Reflecting latest Food Standards Agency advice that:
- it is safe for mothers to eat peanuts during pregnancy, but babies shouldn’t be given them for the first six months of life
- pregnant women should not drink more than 200mg of caffeine a day – that’s two mugs of instant coffee

- Introducing a step-by-step breast feeding guide and information on medicines for common ailments while pregnant or breast feeding

All of this information has been updated in online resources on NHS Choices as it has changed, but these books bring it all together in one handy reference tool for parents.

Commenting on the new books, Health Minister Ann Keen said:

“Parents have told us how useful they find these books and the advice they give, and we’ve listened to their feedback on what extra information they need.  That’s why we’ve updated the Pregnancy and Birth to Five books to include more advice on the topics parents find most difficult including post natal depression and breast feeding.  I would encourage all parents to use these books and their midwife and health visitor to ensure they have all the information and support they need through pregnancy and early years.”

Commenting on the new books, General Secretary of the Royal College of Midwives Cathy Warwick said:

“The RCM is pleased to have helped update these publications and feels that they will be a vital new resource for pregnant women and their families. We believe that they will help empower and educate pregnant women to make informed choices and decisions about their unborn baby and their newborn child’s health.”

As well as offering advice and guidance, the books let parents know what support and contact they can expect from the NHS at every stage of pregnancy and early years.

First time mum-to-be Hannah Plumridge said:

“The new Pregnancy book is really easy to dip in and out of. It’s good to read something that is written from the NHS point of view so you don’t just learn about what is happening physically, but what you can expect at each midwife appointment and what the NHS can offer at each stage of the pregnancy. I thought the section on the labour was the most informative I have read – I now know more about the process once labour begins and what happens afterwards, rather than just physically giving birth.”

Should dads be at the birth?

Leading obstetrician, Michel Odent, says the father’s presence at the birth can lead to his partner needing a caesarean delivery, marriage break-up or mental illness in this weekend’s Observer (18 October).

Michel Odent, a childbirth specialist, also believes the mother-to-be’s labour can be longer, more painful and more complicated because she senses his anxiety and becomes nervous. Next month, Odent will discuss his views at the Royal College of Midwives’ annual conference.

Mary Newburn, Head of Research and Information, NCT, says,

“The NCT believes it’s important that women in labour are given support throughout so they can feel calm, relaxed and reassured. For most women, this means they would like to have some sort of birth companion with them, whether it’s the father, doula, friend or all three.

“Many women feel that having their partner or father of the child present at the birth will enable them to feel calm, secure and supported during the birth.

“However, some women feel that having their partner at the birth will not lead to a calm atmosphere and would prefer them not to be present. Or some partners will not feel comfortable themselves in providing physical and emotional support during labour.

“So, if both parents agree, it can be great for women if their partners are present. For many fathers being present at the birth allows them the opportunity to bond with their new baby and to feel a part of the new baby’s life from the start. Otherwise mothers-to-be should talk about who they would like as their birth companion during labour.”

Folic acid and colorectal cancer risk update

The Agency’s Chief Executive, Tim Smith, has written to the Chief Medical Officer (CMO), Sir Liam Donaldson, with updated information on folic acid and cancer.

In December 2006, the Scientific Advisory Committee on Nutrition (SACN) published its report Folate and Disease Prevention in response to a request from the Department of Health and the FSA. In its report, SACN recommended mandatory fortification of flour in order to reduce the number of pregnancies affected by neural tube defects.

In June 2007, after considering this report and options for improving folate intake of women of child bearing age, the FSA Board recommended mandatory fortification of bread or flour with folic acid. The recommendation to Health Ministers was made with the condition that there are controls on voluntary fortification and clear guidance on the appropriate use of supplements containing folic acid.

In October 2007, the CMO of England, on behalf of UK CMOs, asked SACN to consider in further detail two studies on folic acid and colorectal cancer risk that had not been published at the time of the SACN report.

A working group, comprising members of SACN, the Committee on Carcinogenicity and an external cancer expert, considered these studies and the combined results of trials that had investigated the effect of B-vitamins (including folic acid) on cardiovascular disease, which also reported effects on cancer.

SACN has concluded that the new evidence does not provide a substantial basis to change its previous recommendation for the introduction of mandatory fortification with folic acid, with controls on voluntary fortification. However, SACN’s recommendation has been amended to clarify the advice on supplement use for particular population groups.

Since SACN’s advice regarding mandatory fortification has not changed significantly, the Agency’s advice of June 2007 remains unchanged. Now that the Agency has notified the CMO of SACN’s updated conclusion, the UK CMOs will advise Health Ministers.