Tinto Talks

This week, we continue our Ask a Tinto Expert series with a discussion around children’s mental health with clinical psychologist, Dr Caroline Gibbs.

In the podcast, we talk about how the difficulties of the last 18 months have affected our children’s mental health, including how vulnerable children have become even more vulnerable.

We cover children’s anxiety and the signs that your children might be struggling, including how children often use physical symptoms, such as a tummy ache, to explain their emotions.

We also discuss the best way to access mental health services and the impact children’s mental health can have on parents - and vice versa - and how we can better support them too.

Thank you so much for listening. If you’d like to know more about what we discussed, here are some resources that you may find useful

Anna Freud – Some very helpful Covid research and support/advice for parents and for professionals - https://www.annafreud.org/coronavirus-support/support-for-mental-health-professionals/

Sutton Trust – Early Years research - https://www.suttontrust.com/our-research/coronavirus-impacts-early-years/

Covid 19 Early Years Research Round-Up - http://www.crec.co.uk/announcements/covid-19-impact-early-years-research-round-up

Digestible book aimed at parents whose children are experiencing anxiety:

Helping Your Child with Fears and Worries 2nd Edition. Cathy Cresswell and Lucy Willetts –

Mental Health Tier System

Tier 1: Primary care and first line support: GP, school, nurses, or school-based support e.g. school counsellor

Tier 2: This is what we often refer to as early help, but these tend to be more

targeted services, so you might have a Child and Adolescent Mental Health

Service (CAMHS) service here offering support for mild-moderate mental

health difficulties

Tier 3: Here you have specialist CAMHS, who would tend to see those with

more severe or enduring mental health difficulties, complex: comorbidities.

Here you would have an MDT approach, so you might have input from a range

of professionals including talking therapists and psychiatry. This is also where

specialist CAMHS sits, e.g. eating disorder services, neurodevelopmental

assessment services.

Tier 4: This is where our inpatient services sit and also what we call outreach

services, who aim to prevent children/YP needing an admission and who may

therefore offer a more intensive service, for example, several appts a week for

a short period until things have settled down a bit.

This week, we continue our Ask a Tinto Expert series with a discussion around pelvic girdle pain with physical therapist, Dr Deborah Riczo.

In the podcast, we break down the symptoms of pelvic girdle pain to help you understand any issues you might be having.

We also give some tips on how to manage this pain, covering everything from round ligament pain and our pelvic floors to posture, strength and flexibility throughout and after your pregnancy.

As always, seek professional advice from your GP or a physiotherapist if you have any unexplained aches and pains during pregnancy. Early intervention is key to keep you moving freely.

Thank you so much for listening. If you’d like to know any more about what we discussed, here are some resources that you may find useful.

To hear more from Dr Deborah, take a look at the following:

WEBSITE - https://riczohealtheducation.com

INSTAGRAM: http://instagram.com/RiczoHealthEduca... 

FACEBOOK: http://www.facebook.com/RiczoHealthEd... 

LINKEDIN: http://www.linkedin.com/in/deborahriczo/ 

TWITTER: http://www.twitter.com/DebRiczoPT/

Prenatal and Postpartum Exercises and Posture Tips

Dr. Deb, physical therapist:Pregnancy & Postpartum Exercises for back, pelvic girdle, hip, leg pain

Pelvic girdle pain resource

https://pogp.csp.org.uk/system/files/publication_files/POGP-PGP%28Pat%29%28UL%29.pdf

Pelvic floor exercises resource

https://pogp.csp.org.uk/system/files/publication_files/POGP-PelvicFloor%20%28UL%29.pdf

This week, we continue our Ask a Tinto Expert series with a discussion around pain management during labour with experienced anaesthetist and dad, Dr Dickie Lowe.

In the UK, birth is almost synonymous with pain. But it doesn’t have to be that way. Knowing all the pain management options available to you is such an important part of birth preparation.

First of all, Dr Dickie explains how different factors can influence our experience of pain.

Then, we get into the details, covering gas and air, TENS machines, epidurals as well as breathing techniques, music and massage. We also touch on the anaesthetic involved in c-sections.

Finally, we wrap up with a discussion around managing postpartum pain.

Thank you so much for listening. If you’d like to know any more about what we discussed, here are some resources that you may find useful:

The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis (2016)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192342/

Three acupoints for pain management:

https://www.aurorahealthcare.org/patients-visitors/blog/3-acupressure-points-you-can-use-to-relieve-headaches-stomach-pain-or-nausea-and-body-pain

A guide to massage in labour:

https://shafiamonroe.com/power-of-touch-massage-during-labor/

Using a tens machine in labour:

https://www.babycentre.co.uk/a542581/using-a-tens-machine-in-labour

Pain management for women in labour: an overview of systematic reviews:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009234.pub2/full

(The OAA – Obstetric anaesthetists association) pain relief in labour

www.Labourpains.com

NHS website / Tommys.org

Valentine Gardener from the amazing @postivebirthingandparenting shares with us some of her knowledge about how best to prepare for birth and encouraging postpartum wellbeing.

We cover Hypnobirthing, what it is and how it works and all the other tools you can gather to help guide you through a smooth birth. Tackling fear of birth and how being informed is a huge factor in gaining some control in birth

We then discuss preparing for the transition into becoming a mother both whilst still pregnant and also in the early postpartum period.  Understanding the stresses and strains not just physically but emotionally you about to go through and preparing yourself for the change in identity and working through practical tips with your partner. Techniques such as encouraging boundaries and ensuring rest and some you time- all things that I know I struggled with in the early days.

#Hypnobirthing #Antenatal #Postnatal #Pregnancy #Fearofbirth #Labour #Breath #CBT #Wellness #Positivepostpartum #Wellbeing #Motherhood #Anxiety #Identity #Parenting #Boundaries #Selfcare #Balance #Birthtrauma #Processingbirth #Mama #Matrescence #Maternity #Covid #Lockdownbabies #Isolation

https://www.positivebirthingparenting.com

Val Gardener

http://hypnobirthing.co.uk

https://www.birthtraumaassociation.org.uk

Mothersformothers.co.uk

Pandasfoundation.org.uk

Birthtraumaassociation.org.uk

Anxietyuk.org.uk

Mind.org.uk

https://what0-18.nhs.uk/parentscarers/maternal-mental-health

Healthier Together

https://hampshirelanterns.com/

Hampshire Lanterns

Before you think another homebirth, this is not a common decision first time mothers make therefore it is interesting to document why and how Tash comes to this decision. We have a good chat about choosing the right birth for you, especially during a pandemic. What influences her choices and how to find out what your options are near you.

We talk NCT via zoom, exercise and maintaining strength throughout pregnancy and the realities of the ever-changing pregnant body. We also cover being realistic about postnatal recoveries and how you can nourish and support that journey.

It’s an interesting viewpoint of pregnancy from a women’s health physiotherapist. We discuss the fact that the key is educating yourself about all of the variables that can affect your birth and therefore whatever the outcome you can maintain some control and also be happy with the course of events.

NCT https://www.nct.org.uk

https://advances.sciencemag.org/content/5/6/eaaw0341 Extreme events reveal an alimentary limit on sustained maximal human energy expenditure (2019)

https://www.scarymommy.com/pregnancy-marathon-endurance-athlete/

Emma shares her story of her #electivesection. Though planned it was not a choice. She had #placentaprevia meaning the #placentahad attached itself too close to the #cervix making #vaginalbirth a dangerous option. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

Emma is our third new mother in the series. Living in Amsterdam she is had gone full circle with her decision from planning an elective C -section to wanting a waterbirth in the hospital. However, after discovering she had placenta previa as the pregnancy progressed, this took away her choice meaning the doctors were now advising how best to deliver her baby, an elective c-section. An elective section assumes that it was a choice but, in this instance, Emma had no option over how to deliver her baby. This took some getting used to.

We talk about coming to terms with the decision, gaining information about placenta previa and elective caesareans. Choices you have when having a very medicalised birth. Managing anxiety with mediation and becoming informed. Home preparations and understanding how a section will affect you in the postpartum phase.

Resources:

https://www.rcog.org.uk/en/patients/patient-leaflets/a-low-lying-placenta-after-20-weeks-placenta-praevia/

Information about placenta previa from the royal college of obstetricians and gyaenacologists.

https://www.guysandstthomas.nhs.uk/resources/patient-information/diabetes/antenatal-hand-expressing-from-37-weeks.pdf

Leaflet about how and why to hand express.

Karen achieves her dreams of a home birth but not without some drama.  She describes from the first contraction to the birth. The support of the midwives and pain management techniques. It was the birth she hoped for. Following the third stage, delivery the placenta, Karen describes how she started to feel dizzy shortly afterwards and ended up being transferred to hospital with a postpartum haemorrhage.

1-5% of women have PPH and the risks are actually slightly higher if you give birth in a hospital. Karen had no particular risk factors that would indicate she bleed heavily postpartum.

We talk about the evidence supporting the decisions she took and in hindsight what she would do differently. Namely have the active delivery of the placenta with the injection syntometrine.

She describes her experience as a positive birth where she got the best of both worlds. A calm home birth and due to her hospital transfer, excellent after care from the midwives.

This story is to show you that you can have a positive experience even when things don’t quite go to plan. It’s important to be educated about all things that can happen during a birth to help you make informed decisions that suit you.

Resources:

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-130

Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK (2012)

https://www.nice.org.uk/guidance/cg190/ifp/chapter/Delivering-the-placenta

NICE guidelines for delivering the placenta

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-heavy-bleeding-after-birth-postpartum-haemorrhage.pdf

Royal college of obstetricians and gynaecologists leaflet about postpartum heamorrages

Karen, a first-time mother, talks about the how she came to choose where to give birth. As a Vet with a husband who is an anaesthetist, they were hot on their research and took a very measured and evidence based approach to making their decision. Karen talks us through the research she did, both clinical and anecdotal through conversations with friends and how she did a full circle from wanting an elective c-section to deciding on a home birth. She talks about the benefits of having home visits from the same midwife from the home birthing team once their decision had been made and all of the other preparation, she was doing to for her upcoming birth.

Resources:

Give birth like a feminist. Milli Hill

Hypnobirthing. Practical ways to make your birth better. Siobhan Miller.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext

https://www.england.nhs.uk/wp-content/uploads/2015/07/npeu-report1-safety-of-birthplace-and-implications.pdf

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext