Booking appointment with Irene Vine Midwife

Yesterday I did the first booking appointment of the year. Woohoo. Booking appointments are quite special as it could be the first time you are properly meeting your client, and they are probably the longest appointment in pregnancy.

 
The NHS allocates around 1h to this appointment, as opposed to the usual 20 minutes, whereas we independent midwives give you 2-3h of our time for the booking and 1-2h for regular appointments. Bottom line, our appointments are unrushed and at a time that suits you and your family. I for instance offer weekend appointments and late afternoons weekdays as evenings are hard with our busy household.
 
Another benefit of our care is that we can tailor our information and freebies to your needs. We will be in communication throughout your pregnancy by email or WhatsApp and share our knowledge, sources and also basic information that our guidelines suggest we do. For instance, at the booking appointment we’ll go through healthy eating, foods to avoid, supplements, common pregnancy symptoms, mental health, vaccines, blood tests, ultrasound scans, etc. We will always present you with the basic NHS information first and if you want to know more about any topic we’ll delve deeply into it. Take healthy eating and supplements, did you know that the NHS recommends you avoid vitamin A in the form of supplements and organ meat (liver)? But did you know that the research behind this recommendation was not thorough and it involved mainly supplements? And that as a result some nutritionists do recommend liver in pregnancy as a great source of iron and other nutrients? As independent midwives we also have clients that decline routine checks like ultrasound scans. This is not a problem for us!

Booking Appointment Freebies

With regards to freebies, as you can see in the picture I tend to include a pregnancy journal, some flyers from local businesses (osteopaths, Doulas, baby clothing, pregnancy classes, etc) and discount codes I’ve acquired (cloth nappies, EC, room decorating stickers, etc.). In this pack there is also some coconut baby oil, tea for the bath and lip balm. For this particular client I’ve brought some Christmas sweets from Spain as she has lived in Spain in the past! So they are all personalised to the client, the season and whatever I’ve got access to.
 
Another difference between NHS care and Independent Midwife (IM) care is that we don’t usually take the booking bloods during the appointment. These bloods include a full blood count, your blood group, screening for sickle-cell and thalassemia, HVI, Hep B and syphilis. Most of our clients receive care on the NHS, as you are still entitled to NHS even if you hire private care, so these blood tests and scans get done there. If someone wants to have all their care private, there are ways. For instance in Suffolk pregnancy scans and blood tests can be done at ultrasound direct.
 
Finally, it should be noted that the purpose of the booking appointment is to gather all your medical history to better tailor the care around your needs and involve the multidisciplinary team should you need it and should you want it. It’s also an opportunity to get to know your midwife and take your first step in the discovery journey pregnancy puts you on.
Freebies

Hello! My name is Irene Vine and I am an independent midwife  covering Suffolk, Essex, Cambridge and East London. I provide full antenatal, postnatal and birth care including homebirths and outside of guidelines care. I am passionate about supporting women achieve a birth experience where they feel empowered, heard and understood. If you would like to experience the best possible care with unrushed appointments and a midwife who is always at the other end of the phone, give me a call! I cover most cities and villages in East Anglia, such as Chelmsford, Colchester, Ipswich, Cambridge, Harlow, London or Southend.

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Resources For Fetal Heart Monitoring

1.When did we start monitoring babies in labour?

For more high quality evidence around fetal monitoring please visit Kirsten website here, an obstetrician with a PHD in CTGs. https://birthsmalltalk.com/

In this post she discusses intermittent auscultation: https://birthsmalltalk.com/2023/08/23/what-is-intermittent-auscultation/

Hear her talk about the lack of evidence behind CTGs in this podcast: https://open.spotify.com/episode/1eXZY973Oxbs1ducavpSAk?si=872f8c4077be4ba5

Post on the history of fetal heart monitoring: https://birthsmalltalk.com/2023/08/09/listening-to-the-fetus-the-history-of-fetal-heart-rate-monitoring/

Cochrane review comparing CTG to intermittent ausculation (CTG increases interventions
): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006066.pub3/full

Does CTG use improve outcomes for high risk women? https://birthsmalltalk.com/2024/10/16/the-story-behind-our-paper/

2. How should we use intermittent auscultation in labour?

These are the NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

Midwife researcher and lecturer Rachel Reed has a brilliant article and podcast about this where she unpicks the evidence around the recommendations for intermittent auscultation protocols here https://www.rachelreed.website/blog/listening-to-baby-during-labour

and podcast here: https://open.spotify.com/episode/3sJeIR3xUOr20EBRGilHxl?si=818537594dd04457

The WHO recommendations for intrapartum care: https://iris.who.int/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1

3. How does intermittent auscultation detect fetal distress?

For more on normal and abnormal heart rate monitoring watch this explanatory video: https://www.youtube.com/watch?v=Ni48bbtiZgs

4. What happens if there are concerns with the fetal heart rate at a homebirth?

NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

5.What is better for fetal monitoring in labour: a Doppler or a Pinard/fetoscope?

To read about the research and the experiences of midwives using a fetoscope/pinard antenatally and in labour check these links out.

Short facebook comments compiled in this magazine here: https://www.midwiferytoday.com/mt-articles/wisdom-of-the-midwives-issue-131/

Midwives perceptions of fetoscope vrs Doppler Tanzania https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1736-y

Midwives experiences of Pinard use Norway https://www.sciencedirect.com/science/article/pii/S0266613822000407

Defense of fetoscope article by American midwives

https://hearthandhomemidwifery.com/blog/fetoscope-a-tool-of-the-midwifery-trade#:~:text=Fetoscope%20uses%20go%20beyond%20just,birthing%20person%20and%20the%20baby.

A Cochrane review that compares Doppler and Pinard use in low income countries: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008680.pub2/full

For a compilation of research that compares the use of Doppler to Pinard check this link: https://www.cochranelibrary.com/content?templateType=related&urlTitle=%2Fcentral%2Fdoi%2F10.1002%2Fcentral%2FCN-01110791&doi=10.1002%2Fcentral%2FCN-01110791&p_p_id=scolariscontentdisplay_WAR_scolariscontentdisplay&_scolariscontentdisplay_WAR_scolariscontentdisplay_action=related-content&p_p_lifecycle=0&p_p_mode=view&type=central&contentLanguage=

6. What if you decline some or all fetal auscultations?

Is fetal monitoring essential?: https://birthsmalltalk.com/2024/11/06/myth-busting-3-fetal-monitoring-is-essential/

7. What to bear in mind about intermittent auscultation in labour?

Examples of womens experiences of fetal auscultation in labour: https://www.sciencedirect.com/science/article/pii/S1871519224002658#bib14