Choosing Where to Have Your Baby

If you are healthy and your pregnancy is advancing normally, why not think about having your baby at home?

In your own home environment you will be able to relax and feel at ease, surrounded by whoever you wish as a birth partner/s. Its your home, your choice. The relaxed surrounds supports the natural process of labour and birthing, and women often find they need less pain management in their labour.

If you choose to have a home birth, we have a dedicated home birth midwife on duty, who will come to your home around 36 weeks to guide you in the practicalities of preparing your home. They are usually items you have in the home anyway, so don’t be concerned that there is any added cost. She will help you to decide which room you would like to birth in and the logistics to consider depending if you live, for example, in a flat. We will bring with us some essential items prior to the day, so we are fully prepared. Don’t worry about there being a mess, as midwives are very discreet and excellent at minimising any visual ‘mess’. The midwife will discuss any concerns you may have and answer your questions.

What pain management options are available? 

Some women choose to hire a birth pool or a TENS machine (transcutaneous electrical nerve stimulation). You would be encouraged to remain mobile as you feel you can, to ensure your baby is in the optimal position. The Midwife will provide gas and air (entonox) should you need this, and support you in how to use this. Some Community Midwives can offer massage and aromatherapy.

What happens in an emergency?

Our community midwives are experienced in supporting you, giving dedicated 1:1 care at home and are trained to deal with emergencies. If the midwife has any concerns before, during or after the birth, with either you or your baby, your midwife will discuss these with you and explain and guide you through the next steps to take. If you require a transfer to hospital, this will be by ambulance and your midwife will stay with you and continue to support you for the journey.

What happens after the birth?

On birthing at home, your midwife will encourage you and your birth partner to have skin to skin with your baby, and encourage the building of a special bond. You will be supported in your chosen method of feeding your baby, and practical support and guidance given. If breastfeeding, we will ensure that you have the skills to feed your baby, and encourage you towards being independent and confident before we leave your home.

Your community midwife can answer any questions you may have and will be happy to discuss planning your homebirth with you.

For more information for you and and your partner on planning where to give birth visit: 

www.nhs.uk

www.nhs.uk (First baby)

www.nhs.uk (If you have given birth before)

Read about antenatal appointments and care on NHS.uk

North Bristol NHS Trust has a dedicated Rapid Access Clinic for people suspected to have giant cell arteritis. 

We are happy to discuss any possible cases and would rather see them pretreatment with glucocorticoids.

We will normally see patients within 2 days, organise a temporal artery biopsy and start treatment if appropriate.

Characteristics suggestive of GCA

• Advancing age over 50 years (typically over 60 years)
• Raised ESR/PV and/or CRP
• Jaw/tongue claudication
• New headache (usually unilateral, temporal)
• Scalp pain and tenderness
• Temporal artery tenderness or reduced temporal artery pulse
• Visual symptoms and signs including diplopia. If eye symptoms contact the Eye Hospital. 

If the PV and CRP are low and the patient is <60 years old, be very suspicious of an alternative diagnosis.

In case of visual symptoms or signs, phone urgently the Ophthalmology on-call at the Bristol Eye Hospital.

Referrals should be made via switchboard on 0117 9505050 and ask for the on call rheumatologist between 8am-4pm Monday - Friday and 9am-12noon Saturday and Sunday.

Shared care protocols and advice for DMARDs & Biologics

These sheets provide guidance on monitoring of DMARDS in primary care.

For the full shared care protocols and responsibilities for primary care refer to 

DMARDs (BNSSG joint formulary updated September 2012)

• Azathioprine
• D-Pencillamine
• Gold
• Hydroxychloroquine
• Leflunomide
• Methotrexate
• Sulphasalazine

Anti TNF

• Anti-TNF monotherapy
• Tocilizumab monitoring guidelines
• Safety of anti TNF treatment in males wishing to father children

Pain clinic can be accessed by a referral from your GP, physiotherapist, your local Musculoskeletal Assessment and Treatment Service and the spinal surgery services at Southmead Hospital Bristol.

Back Pack can be accessed by a referral from your GP, physiotherapist, your local Musculoskeletal Assessment and Treatment Service (MATS), the spinal surgery services at Southmead Hospital Bristol, and the Pain Clinic at Southmead Hospital Bristol.
Once we have received your referral, we will offer you an individual assessment with the specialist physiotherapist prior to starting the group.

Pain Management Programme Groups (PMP) are accessed only from the Pain Clinic, because these groups are only available to people with pain that cannot be relieved by the treatments that are currently available. Before somebody joins one of our PMP groups, it is important that they have had this assessment within the Pain Clinic, so that any possible options for pain relief can be explored. You will also need to have an initial assessment, with a psychologist specialising in chronic pain, and then attend an information meeting

A Self-Management Programme (SMP) can be accessed by a referral from your GP, physiotherapist, your local Musculoskeletal Assessment and Treatment Service (MATS), the spinal surgery services at Southmead Hospital Bristol, and the Pain Clinic at Southmead Hospital Bristol.
Once we have received your referral, we will invite you to attend an Introductory Meeting so that you can find out more about the courses that we offer. Once you have attended an Introductory Meeting, you can choose to have an individual assessment so that we can discuss the different options available and we can then offer you a place on a course. The SMP courses run in different venues around Bristol, and we will try to offer you a place on the most convenient course for you.

GMC Number: 4634069

Year & location of first qualification: 1999, London

Specialty: Neurology 

Clinical interest: Cognition and dementia

Secretary: Helen Selman

Telephone: 0117 414 6691

Professor Elizabeth Coulthard trained to become a neurologist in Oxford, London and Bristol. 

Since 2011, Professor Elizabeth Coulthard has developed a multidisciplinary cognitive disorders clinic. The clinic specialises in early diagnosis of the different diseases that results in dementia, such as Alzheimer’s disease. The clinic also offers a range of treatments including a Brain Health lifestyle advice clinic. Clinical research is at the heart of the clinic’s practice and offers a range of treatment trials. Professor Elizabeth Coulthard’s academic research aims to better understand sleep and brain health in order to develop future treatments.

GMC number: 4090155

Year of first qualification: 1994, Cambridge University

Specialty: Plastic Surgery

Clinical interest: Skin Cancer, Dermoscopy, Management of melanoma 

Secretary: Joanne Hawkins

Telephone: 0117 414 7607
Email: joanne.hawkins@nbt.nhs.uk

Mr Dominic Ayers is a specialist in skin cancer and skin lesions within the Plastic Surgery Department at North Bristol NHS Trust.

All of Dominic Ayers’ elective practice in plastic surgery is skin lesions and skin cancer. An important part of this is the Pigmented Lesion Clinic, where patients are referred direct from their GPs.

He has further regular clinics where he see patients with skin lesions and skin cancer who are referred by their GP but also sent on from Dermatology colleagues with whom he works closely.

His particular interests are dermoscopy, management of melanoma and care of the elderly with skin cancer. 

Mr Ayers outpatient clinics are held both in Bath and North Bristol.

Year of first qualification: 1995

Specialty: Urology

Clincial interests: Uro-oncology, Kidney and Testis Cancer, Andrology

Secretary: Amy Wheeler

Telephone: 0117 4145002

Email: urologykidneyoncologyadminteam@nbt.nhs.uk

Mr Salah Albuheissi received Specialist UrologicTraining in open, laparoscopic and robotic surgery in the Southwest of England, Cleveland (USA) and Austria. His special interest is in the management of kidney,testis and retroperitoneal cancers. He also manages other conditions including erectile dysfunction, prostate and bladder problems.

His main research interest is uro-oncology & Andrology.

GMC number: 4213433

Year of first qualification: 1995, Oxford University

Specialty: Plastic and Reconstructive Surgery

Clinical interest: Skin cancer, burns, scarring and general plastic surgery

Secretary Jane Baker

Tel: 0117 414 7629

Mr Jon Pleat is a plastic surgeon with a general interest in burns, scarring and reconstructive surgery.

He trained in Oxford, Bristol and plastic surgery services within the UK and abroad.

He is a past-Director of Research for the burns and wound healing charity, Restore.  His research interests encompass first aid, wound healing, scarring and burn management. He collaborates with multiple research groups at the Universities of Bristol, Oxford and The University of the West of England.  He is a principal investigator on national and international research projects including OptiThermm and ELABS.

Mr Pleat was one of the founding editors of the national primary care resource, GPNotebook.

He is deputy Chair and a trustee to The Skin Cancer Research Fund, the oldest skin cancer charity within the United Kingdom.  He is also a member of the steering committee of The Center for Appearance Research at The University of the West of England.  

He is a member of The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), The British Burns Association (BBA) and The European Burns Association (EBA).

Year of first qualification: 1998, University of London

Specialty: Colorectal Surgery

Clinical interest: Laparoscopic colorectal surgery, Endometriosis and pelvic surgery

Secretary: Megan Hopes

Telephone: 0117 414 0835

Miss Kathryn McCarthy studied at UCL 1993-1998, MD University of London 2005, FRCS Royal College of Surgeons of England 2007, Gynaecological fellowship, 2009, Laparoscopic subspecialty fellowship, Glasgow 2011-12.

Her academic interests include the IGF pathway in colorectal cancer and surgical outcomes in older people (www.OPSOC.eu). Her subspecialty interests include minimally invasive trans anal surgery, early rectal cancer and pelvic floor surgery.

She is clinical lead for Endoscopy, GI physiology and nationally, NIHR lead for surgical research (West of England).

She is also a member of The Royal College of Surgeons of England, National Pelvic Floor Society and European Society of Coloproctology.