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 0117 975 6006 Pandasfoundation.org.uk 0843 289 8401 Birthtraumaassociation.org.uk 01264 860380 Anxietyuk.org.uk 0344 477 5774 Mind.org.uk 0300 123 3393 https://what0-18.nhs.uk/parentscarers/maternal-mental-health Healthier Together https://hampshirelanterns.com/ Hampshire Lanterns

This week on Tinto Talks, we top off our birth stories series with first-time mum Tash's forceps delivery during a pandemic. This episode is the final part in our birth stories series, where we talk to mums before and after their births. Tash and Octavia start by discussing the realities of giving birth and having a newborn during a pandemic. It's not quite the maternity leave Tash imagined, and the lack of social contact has – understandably – had an impact on her and her little boy. We then deep dive into Tash's birth story. Tash describes how, 24 hours after her water broke at home, she was admitted to hospital as she was not progressing apart from a few Braxton Hicks. After agreeing to an induction, Tash explains how quickly the contractions started and how she managed the pain with an epidural, delivering her son safely with an episiotomy and forceps. Octavia and Tash talk through informed consent, episiotomy and how to minimise birth trauma even when things don't go to plan. Towards the end of the podcast, Octavia and Tash discuss recovery, including going to the loo with stitches, haemorrhoids, scar massage, pelvic floor exercises and Mummy MOT. And finally, we round it off by talking through some coping mechanisms for dealing with the strain of Covid as a new mum and how we're trying to find gratitude among the loneliness and monotony of lockdown. 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: https://www.tommys.org/pregnancy-information/giving-birth/what-expect-when-your-waters-break What to expect when your water break https://www.tommys.org/pregnancy-information/giving-birth/braxton-hicks Braxton hicks https://www.esht.nhs.uk/wp-content/uploads/2017/06/0331.pdf Information for women planning to give birth at home https://www.nice.org.uk/guidance/cg70/documents/induction-of-labour-update-of-guideline-d-nice-guideline-for-consultation2 Guidelines for induction and alternative methods: https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/episiotomy-and-perineal-tears/ Episiotomy https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/forceps-or-vacuum-delivery/ Forceps deliveries: https://www.nhs.uk/conditions/piles-haemorrhoids/ Haemorrhoids: https://www.google.co.uk/amp/s/heavy.com/baby/2017/09/top-best-perineal-ice-packs-postpartum-cold-instant/amp/ Ice packs: https://pubmed.ncbi.nlm.nih.gov/26395154/?fbclid=IwAR1HgZBmCJDk4Bf2VT5W0NGuu0uRc902g5PFt5UrRlHejU5IMX44wk_6B8Q Evidence for ice pack https://www.amazon.co.uk/Perineal-Cold-Packs-Need-Freeze/dp/B01N9JEKY8 Cold pack for stiches or post partum https://myexpertmidwife.com/products/spritz-for-bits?gclid=Cj0KCQiA0fr_BRDaARIsAABw4EsyCtI7SUeikl44wxcsiU8hxTjHVpnOPvQ96Lwcwm4l2vYEswzwXj0aAiLyEALw_wcB Spritz for bitz https://www.guysandstthomas.nhs.uk/resources/patient-information/therapies/physiotherapy/massage-perineal-episiotomy-caesarean-scars.aspx Scar Massage https://www.bristolmassagetherapy.co.uk/tips-articles/massaging-a-c-section-scar Scar massage https://www.themummymot.com The Mummy MOT

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. We hear how the birth went with everything from the night before, the #spinalblock, what it feels like during the #surgery and the #euphoria for hearing and seeing your baby for the first time. We also cover in depth the concept of a #gentlecaesarean - music of your choice in the #operating theatre, emerging slowly from the #incision, #delayedcordclamping and the controversies of #vaginalseeding. We touch on initial challenges of struggling to #breastfeeding with support of #nightnurse and #doula she is managing well now Finally, we cover the #recovery. How managing hers and her #husbands' expectations was crucial to enabling a good recovery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/ Caesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis (2011) https://www.tommys.org/pregnancy-information/labour-birth/delayed-cord-clamping-dcc#:~:text=NICE%20guidance%20recommends%20that%20cord,away%20to%20get%20breathing%20support. Delayed cord clamping https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648605/#:~:text=Studies%20have%20shown%20that%20there,microbial%20profiles%20of%20their%20newborns. The Maternal Infant Microbiome: Considerations for Labour and Birth(2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599328/ The microbiome seeding debate – let's frame it around women-centred care (2019) https://www.nuh.nhs.uk/caesarean-birth-c-section/ Video of The gentle section Nottingham University hospital https://www.naturalabundance.me/cut-now-anatomy-c-section/ Video of what they cut through in a sectionnk

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

Ruby shares her amazing story of being induced but managing to maintain control of the situation and still having the birth she dreamed of. Insight into managing her birth plan, encouraging a calming atmosphere even though in the obstetric unit to ensure a positive and empowering birth story she so desired. Due to not being able to have an epidural because of low platelets, Ruby talks through her pain management techniques from TENS to being in the birthing pool and use of the app Freya. Such as positive story even though things didn't quite go to plan. Resources: The First Forty Days: The Essential Art of Nourishing the New Mother. Book by Amely Greeven, Heng Ou, and Marisa Belger Freya app: https://thepositivebirthcompany.co.uk/freya-hypnobirthing-app @Motherbees @thefirstfortydays

Ruby discusses her desire for a homebirth, what influenced her decision, the books she had read, hypnobirthing courses attended and the research she did. We also discuss and the controversies surrounding peoples birth choices and the importance of supporting women whatever their story. We discussed pregnancy in a pandemic and the benefits of choosing a home birth meaning continuity of care as you are allocated a midwife and they come to your home. Finally, we discuss the fact that Ruby's platelets are low and this means she is starting to prepare herself for the fact that she might need to be induced meaning she will need to be in the obstetric unit for the birth. Resources: https://thepositivebirthcompany.co.uk https://www.england.nhs.uk/wp-content/uploads/2015/07/npeu-report1-safety-of-birthplace-and-implications.pdf

Dr Nina Fuller-Shavel and one of the co-founders of Tinto, Dr Hannah Allen, speak about functional medicine and its role to support fertility and compliment IVF treatment. We talk about how nutrition and stress can hugely impact fertility and how lifestyle changes and a holistic approach, through functional and integrative medicine, can help you conceive.  The key is treating the root cause of conditions often overlooked by conventional medicine. We cover poly cystic ovaries syndrome (PCOS) and how important early diagnosis is to help prevent further problems down the line. And finally, talk about hormones and that suffering in your cycle, periods with extreme pain, excessively heavy flow or mood swings is not normal and help is out there. Such a great interview with so much more on the topic of women's health. Definitely worth a listen for anyone planning to start a family. EXPERT OPINION

Cervical cancer survivor goes on to have a baby against all of the odds. Hear Philippa's incredible survival story of #cervicalcancer at the age of 29. Following radical surgery to remove her cervix she was still young and hadn't really thought much about starting a family. 7 years later when she met her husband and started down the path for trying for a baby, things weren't working like they should. After many investigations she realised a fallopian tube was crushed in the original treatment of her Cancer. By this stage she was 2 weeks before her 40th birthday, a cut-off point for free IVF in the NHS in most postcodes. So began her #IVFjourney. 3 rounds later and a lot more drama baby Eleanor arrived against all the odds. 51% of women survive a cervical cancer diagnosis for more than 10 years. 99.8% are preventable though. Highest incidence is between the age of 30-34. HPV vaccines are reducing the numbers of new cases as vaccinating against the virus that causes the abnormalities and then cancers in the cells. #cervicalscreening is the next best thing as early detecting leads to early intervention. MAKING BABIES

Meet Olivia. She talks to me on Instagram live about hers and Lucie's story of their journey to starting a family. The process of referral, and then once in the system the options of IUI or IVF, sourcing a donor and potential costs. This is not just a story for gay couples. Any person seeking to start a family that requires assistance for fertility will find this relevant and helpful. Olivia also highlights a very interesting point that women are not taught enough about their bodies and fertility in school or...ever. We only become aware of what is required to make a baby when we are mentally ready and often this doesn't match up with whether our bodies are ready, or past the optimal point of conception. MAKING BABIES

Choosing where to have your baby is something that probably isn't discussed in as much detail as it should be during your antenatal appointment unfortunately. Liz and Elidh, top London midwives, talk us through what your options are from home birth, midwife led and obstetric units. We also cover pain management options, elective caesareans and going private. We talk about the stats supporting each choice and what you should consider when making the decision and things you should try not to worry about. We also talk a little about how the process of labour is supported by a calm and consistent environment. Finally, we end with the birth stories of both midwives and Idia which ranges across all of the options from home birth to emergency c-section and here you realise just how varied the spectrum of births can be, no matter your back ground or training. EXPERT OPINION Resources NHS England https://www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/ NHSE - your choice -where to have your baby The Bump class https://www.thebumpclass.com https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/05/C0441-maternity-leaflets-cv19-planning-your-birth.pdf The birth place study. https://www.england.nhs.uk/wp-content/uploads/2015/07/npeu-report1-safety-of-birthplace-and-implications.pdf NICE guidelines for elective c-sections. https://www.nice.org.uk/guidance/cg132

I meet with women's health specialist Michelle Norton-Hughes from www.rebuildandthrive.co.uk for a a whistle stop tour of exercise in the perinatal period. We cover exercising in the early days, what to avoid from the second trimester onwards, pelvic girdle pain, incontinence and running during pregnancy and postnatally. We finish with a little on diastasis recti (abdominal separation), how to return to sport safely after your birth and when to seek professional advice. EXPERT OPINION

Here is the first of many birth stories. Meet Charlotte, a new mother of two who shares with us her story of birthing during a pandemic but also a successful vaginal birth after c-section (VBAC). We cover how she came to her birthing decision, prepping for birth in lockdown and then talk through how the labour went. We look at the support she received throughout her pregnancy and birth and some stats on VBAC's. BIRTH STORIES