Thursday, 27 March 2014

Jackie Gandy, lead midwife for women-centred care at QMC, on the benefits of a water birth

Every year, hundreds of women at Nottingham University Hospitals use a birthing pool during their labour.

The benefits are well-documented. Being in the water is a very effective form of pain relief and can help with relaxation, so we are delighted to have opened two new pools in our labour suite – meaning even more women will be able to try a pool during their labour.

One of the pools is on the consultant-led side of our labour suite, which is a first for us. It means women who may previously not have been able to use a birthing pool are now getting this opportunity.

This might be women with a long–term health condition, or perhaps someone who has had problems during a previous labour.

It may be that some women won’t actually give birth in the pool, but will use it in the early stages of labour to help relieve some of their discomfort. Last year more than 250 women used a pool at some stage of their labour at QMC, and the new pools mean that this figure will continue growing.

Women who have used a birthing pool generally tell us they have had a positive labour experience, and water is recommended by the Royal College of Midwives which states there are “considerable perceived benefits of using immersion in water during labour”.

This includes not only relaxation and pain-relief, but it’s also much easier to move around in the water, without the pressures of gravity, which means women are able to get in the best birthing positions.
More women will now be able to use birthing pools, like this one at the City Hospital
This can result in a quicker labour – meaning less need for the use of drugs, whether that’s for pain relief or to speed things along. This obviously means fewer side effects for mum and baby.
It is particularly effective when used in conjunction with aromatherapy – another service we are able to offer to many women that come in to our labour suite.

My role is all about helping to ensure that women have the best possible birthing experience and, while water is not for everyone, it is great to be able to offer more choice to more women.

Thursday, 20 March 2014

Liz Roper and Will Hadfield took the ration book challenge to raise awareness of Nutrition and Hydration week

This week (17-23 March) is Nutrition and Hydration Week 2014. We wanted to raise awareness of the importance of nutrition and hydration, so last week we decided to take the ration book challenge.

The ration book challenge involves living on post-war rations for a week. Our diet consisted of rationed meat (1s 2d or £2.67 worth), fish (one tin), eggs (one per week, or two if pregnant), milk (3 pints per week) and sweets (3oz 75g). Offal was allowed freely (strange – no one took this offer up!) Anything else had to be taken from our imaginary allotments - meaning if it can be grown, we could have it.

There are two ways of tackling a challenge. Firstly, half-heartedly and eventually giving up. Secondly, with full vigour and gritted teeth. We decided to take the second approach and really give it our all. A couple of days in, we were definitely reconsidering.

Potatoes made up a large part of the diet, featuring frequently in one form or another. Keeping up protein intake through beans and pulses was a challenge, not to mention a test on our relationships. The thought of miraculously getting pregnant overnight just to have that extra egg did cross my mind.

After researching how people ate during rationing it became clear that you had to be very inventive, but also that it was very time consuming. In this busy life we lead now, it would need a lot of planning.

National surveys report that as a nation, we are appalling at reaching our recommended 5-a-day of fruit and vegetables. One positive of the challenge was that the amount of fruit vegetables we ate rocketed. It really is amazing how inventive you can be with all that veg! As the week went on we became very bored of potatoes, even though we were managing to be quite inventive, and bananas seemed an item of luxury.

This was the real-world application of our challenge, but it’s important to remember what nutrition and hydration week is all about – focusing on nutrition and hydration as an important part of quality care, experience and safety improvement in health and social care settings. With that in mind, here’s what we learnt:

  • Relying on quick and easy food has become an integral part of our lives. We need to make more time for our food and actually stop and think about what it is we put in our mouth. No doubt this will save me money as well, as all too often we think of food as a throw away commodity.
  • We have it all too easy these days. With technology and gadgets making everything that bit quicker, we can hardly imagine life in a post-war Britain. If people could make it through life back then (and stay healthy!) then we can do the same today. It’s an attitude adjustment – no more excuses when we reach for that ready meal.
  • We are going to start appreciating food and drink more, including where it’s from and how it got to us. The fact that we are not restricted on a daily basis shouldn’t mean that we take it for granted. Food is an important part of life, and this is what nutrition and hydration week is all about.

We were very grateful when the week was coming to a close, but we did manage it. Some dishes were so tasty that we plan to publish them later in the year and hope to discuss our efforts with anyone that is willing to listen, especially patients and members of the public that actually lived on rations.

This challenge meant we went into Nutrition and Hydration week with a very positive approach. We hope everyone will take notice that when it comes to patient care, food and hydration are as important as medication.

Liz Roper, Chief Technician and Will Hadfield, Diabetes Specialist Dietician, are part of the department of Dietetics and Nutrition at Nottingham University Hospitals.

You can follow Nutrition and Hydration week on Twitter at @NHWeek, or get involved with #NHW2014. 

Wednesday, 12 March 2014

Prof David Baldwin, Respiratory Consultant, talks about No Smoking Day

As a respiratory consultant, I witness day-to-day the life changing effects smoking has on people and the impact it also has on their loved ones.

Smoking is thought to cause about 85% of lung cancer. This cancer is the second most common in men and women and unfortunately kills more people in the UK than breast and bowel cancer combined.

The reason that lung cancer kills so many is that people present with symptoms when the cancer is advanced and treatment at this stage is palliative and, on average, only improves survival by a few months.

Screening for lung cancer using CT scans offers some hope: this has recently been shown to be effective in detecting lung cancer early when it can be cured. The National Screening Committee and the Department of Health Science and Technology Committee are currently considering evidence and proposals for a screening programme. However stopping smoking is the most effective method of reducing death from lung cancer.

People who have never smoked have under a 0.5% risk of dying from lung cancer by the age of 75. People who stop at the age of 60 have an 11% risk. The earlier people stop, the less risk. Stopping smoking (or never starting) is incredibly important which is why there is now so much anti-smoking legislation. Despite this 20% of people still smoke.

Quitting smoking is very difficult for some people because it is highly addictive. There are a variety of smoking cessation aides including nicotine replacement therapy and some drugs; these are more effective if given with counselling and if the individual is motivated.

E-cigarettes also seem to be effective in reducing the number of cigarettes people smoke and are favoured as one method of “harm reduction”. However, as e-cigarettes are relatively new, research into the long-term health implications is minimal, which is why it is important we monitor the health effects of these.

If you are a smoker, I would urge you to take No Smoking Day as an opportunity to do the best for your health and reflect of the danger of smoking and try to quit. If you know a smoker, you should do a good turn and encourage them to quit.

Monday, 10 March 2014

Maria Matthews, research facilitator with a background in health psychology and social media, talks about the neknomination craze

Many of you will be familiar by now with the term “Neknomination”, the drinking game that is currently spreading across social media. 

The game invites individuals to video themselves downing a large quantity of alcohol in a short space of time and then nominating their friends to do the same, often with the suggestion that failing to do so will result in losing face. The game carries a number of worrying implications and has already been linked to a number of deaths across the world. 

Drinking a large amount of alcohol in a short space of time could lead to alcohol poisoning, which puts the drinker at risk of choking or inhaling their own vomit, can affect the nerves which control breathing and heartbeat, and can lead to dehydration, hypothermia, seizures and death. Being intoxicated also impairs brain function, leaving individuals vulnerable to accidents and injury, antisocial behaviour and hazardous behaviours such as unsafe sex.

Perhaps the most disturbing issue with Neknomination is the ability for videos on social media sites such as Facebook to go “viral”, meaning not only are individuals exposed to the possibility that their drinking antics may be uncovered by future employers, spouses and family years down the line, but also that children and teenagers as young as 10 are witnessing and potentially mimicking the dangerous behaviours displayed in these videos.

Despite the minimum age requirement of Facebook being 14, many younger children have a Facebook account and a high number of teenagers under 16 use Facebook on a regular basis. Young people are especially at risk of the complications associated with alcohol use and are all the more susceptible to peer pressure and the peril of “cyber bullying”. Young people in particular are heavily influenced by the behaviours of their peers, which may be further exacerbated through social media, particularly if youngsters are continually exposed to their peers engaging in certain behaviours such as drinking and smoking online. The fact that users are publicly dared to take part (and therefore potentially publicly “shamed” if they do not) makes Neknomations a rather perturbing concoction indeed.