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Monday, 29 April 2013

Registering births.

I read a truly awful account in the AIMS Journal (Vol 25, No 1, 2013) about a free-birthing couple who were horribly bullied by the health service and social services in South Tees.  One of the bullying tactics was the with-holding (by the midwives) of the notification of birth which delayed the baby's registration and caused problems with the issuing of her NHS number.  Quite how the midwives have been allowed to get away with this is beyond me.  

However, as AIMS points out in relation to the 1907 Notification of Births Act, found here:

"it shall be the duty of the father of the child, if he is actually residing in the house where the birth takes place at the time of its occurrence, and of any person in attendance upon the mother at the time of, or within six hours after, the birth, to give notice in writing of the birth to the [Registrar] .........."

The Births and Deaths Registration Act of 1953 is quite clear:

"The following persons shall be qualified to give information concerning a birth, that is to say—
(a) the father and mother of the child;
(b) the occupier of the house in which the child was to the knowledge of that occupier born;
(c)any person present at the birth;
(d) any person having charge of the child."

The Act can be found here:

Basically, the notification of birth is usually signed by the attending midwife and this automatically alerts the registrar and the parents turn up some time later and sign and collect the baby's birth certificate.  So it is a 2 phase process - notification and later registration, either of which can be done by the father.  A letter notifying of the birth should suffice as this is essentially what has passed between hospitals and registrars.  Of course nowadays it is all automatic via computer link but that is not a pre-requisite for registration.

The NHS number is issued as part of this process but the LSAMO (see website below) should be able to obtain an NHS number for the baby if the midwives will not oblige.

So the NHS number is really a separate issue and can be dealt with over a period (hospitals have a way of accessing an NHS number in an emergency e.g. for visitors arriving from overseas and being rushed straight to A & E with a DVT for example).  My advice would be:

a) see if a local midwife or Supervisor of Midwives will notify the birth if you are happy to contact one within the 6 hours mentioned (this will sort the NHS no issue too); or
b) write a simple letter to the local registrar advising of the birth (date, time, sex etc); and 
c) wait a week of two to see if the registrar writes back and then visit to register in the usual way.  In theory you should be able to sign the register and obtain a birth certificate; and
d) ask your GP or health visitor to sort out the NHS number or contact the LSAMO.

Sunday, 21 April 2013

Group B Streptococcus

To have or not have intrapartum antibiotic prophylaxis (IAP) if you have been found to have Group B Streptococcus (GBS)?

A recent Cochrane review of IAP found insufficient evidential support for IAP in terms of reducing early-onset GBS in the baby, that is infection in the first week.  This review can be found here.
90% of GBS infection in babies occurs in the first week.

What about later onset GBS disease in babies (that 10% which occurs between 7 days and three months of age)?  IAP has been found to lessen the severity of later onset GBS disease in babies in a recent retrospective cohort study.  However later onset GBS is rare, affecting around 1 in 4000 term babies.  The authors of this paper agree that GBS transmission is poorly understood and that IAP is insufficient to prevent mother-to-baby transmission.

It is a personal decision whether to have IAP but the evidence supports a decision to decline IAP every bit as much as it supports the decision to go along with it.

What is important is the recognition of GBS disease in a baby and an effective response to that by parents and healthcare services.  GBS is not a contra-indication to homebirth whatever the parents' decision is about IAP.

Signs of GBS in a baby:
- Poor feeding
- Lethargy
- Irritability
- High or low temperature
- High or low or irregular heart rate 

Anxious or stressed appearance
- Blue appearance (cyanosis) or paleness (pallor) with cold skin
Breathing difficulties such as flaring of the nostrils, grunting noises, rapid breathing, short periods without breathing