Reconstructive Prosthetics provides services to help rehabilitate patients following a traumatic event, disease removal or body-part absence from birth, when surgical reconstruction is not possible or favourable. 

We can provide smaller bespoke facial and body prosthetics, burns and scar splints, aid planning surgical procedures with surgeons, as well as manufacture implants (such as cranioplasty plates and gold eyelid weights).  We provide an internal/external device for the surgeon or patient to use, all of which are custom-made specifically for each person.

Usually referred to us by a consultant surgeon, you will receive an appointment from us to discuss your needs. During your initial appointment, we will discuss with you what we can provide, how it may help you and what is involved in the process. 

For prostheses, you may be required to attend several appointments to take impressions, try prototypes made for you in wax, colour match silicone to your skin tone and to fit the final prosthesis.

Other devices may take less time and may only require one or two assessment appointments (such as for gold eyelid weight appointments).

If you are given a prosthesis or device to use, this may require regular follow-up to us for adjustments or renewing for the time that you use it.

Most people have a frenulum under their tongue. This frenulum can sometimes be referred to as a tongue tie if it is tight and restricting the movement of the tongue.

In Bristol about seven - eight % of babies will have a tongue tie divided to help them breastfeed easier.

What are the signs that my baby may have a tongue tie?

• Baby unable to latch onto the breast
• Your baby may latch but then slip off the breast and need to keep reattaching
• Baby may latch and feed well but it is very painful for mother.

Tongue tie may mean that your baby doesn’t remove your milk very well and this can cause problems with:

• Engorgement 
• Mastitis
• Baby losing more than 10% of birthweight
• Baby taking more than 14 days to regain birthweight.

If you think your baby may have a tongue tie please speak to your midwife or health visitor about your concerns. You can also talk to a breastfeeding counsellor at your local support group.  Your midwife or health visitor will assess feeding and then can refer you to the Infant feeding specialist midwife for assessment of tongue function.

Tongue ties are only divided if they are causing problems with breastfeeding. If your baby has a frenulum that is not causing any problems then it will not need to be treated. This is why we don’t examine all babies for tongue tie at birth.

Many women experience tears to some extent during childbirth as the baby stretches the vagina. For some women, the tear may be deeper and involve the muscle at the bottom of their back passage, called the ‘anal sphincter’. This muscle is important in preventing the leakage of gas (‘wind’) or faeces (‘poo’) during normal daily activities. Therefore, it is very important to identify a 3rd or 4th degree tear and repair it properly. If the tear involves only the anal sphincter muscle, it is called a 3rd degree tear. If the tear extends further into the lining of the anus or rectum, it is known as 4th degree tear.

How common are 3rd or 4th degree tears?

Overall, a 3rd or 4th degree tear occurs in about three in 100 women having a vaginal birth. It is slightly more common in women having their first vaginal birth, compared to women who have had a vaginal birth before.

What increases my risk of a 3rd or 4th degree tear?

These types of tears usually happen unexpectedly during birth and most of the time it is not possible to predict when it will happen, however, it is more likely to happen if:

• This is your first vaginal birth
• your baby is born facing upwards
• You have a large baby
• You have a long labour
• You need help with the birth by forceps or ventouse
• You have had a 3rd or 4th degree tear before.

What will happen if I have a 3rd or 4th degree tear?

This will need to be repaired in the operating theatre under an epidural or spinal anaesthetic or very occasionally a general anaesthetic. During the procedure, antibiotics are given to prevent infection and a catheter (tube) is passed into the bladder to allow drainage of urine.

After your repair, it is recommended that you take the following medications:

• Regular pain killers. Do not wait until you are in pain, but take them on regular basis for the first few days and subsequently as you require them
• A course of oral antibiotics for one week to reduce the risk of infection that could lead to break down of the repair
• Laxatives for approximately two weeks to make it easier and more comfortable to open your bowels.

None of the medications will prevent you from breastfeeding your baby, however, if you have any concerns please speak to your midwife.

You will be advised to:

• Wash your hands before as well as after using the toilet
• Wash your perineum after every visit to the toilet, preferably with warm water
• Pat/wipe the area dry with toilet paper. Always wipe, front to back to avoid contamination from your back passage
• Change your sanitary towels regularly, at least every three to four hours
• Avoid standing or sitting for long periods
• Check your perineum for signs of infection. If the area becomes hot, swollen, weepy, smelly, very painful or start to open, or you develop a temperature or start feeling unwell, please let your midwife or GP know
• Begin doing your pelvic floor exercises as soon as you can – this will strengthen the muscles around the vagina and anus, increase the blood supply and help with healing.

You will be offered physiotherapy advice about pelvic floor exercises before going home.

What can I expect to go home?

After having any tear or an episiotomy, it is normal to feel pain or soreness around the tear for two to three weeks after giving birth, particularly when walking or sitting. Passing urine can also cause stinging. Continue to take your painkillers when you go home.

Most of the stitches are dissolvable and the tear should heal within a few weeks, although this can take longer. The stitches can irritate as healing takes place and uou may notice some stitch material fall out, both are normal.

To start with, some women feel that they pass wind more easily or need to rush to the toilet to open their bowels. Most women make a good recovery, particularly if the tear is recognised and repaired at the time. Six to eight in ten women will have no symptoms a year after birth.

When can I have sex?

It is best to resume sex after the stiches have healed and the bleeding has stopped but there is no right or wrong time. For some people, it is within a few weeks but for others it can be when they feel ready.

Follow up

If you had a 3rd degree tear, you will be contacted by one of the gynaecology specialist nurses after three months from having your baby to ask whether you are still having problems such as: uncontrollable leakage of wind, staining of underwear with faeces or uncontrollable leakage of faeces.  If you are having any of these or other problems, you will be referred to the uro-gynaecology clinic, where we see women with problems of the pelvic floor. If you have really troublesome problems, talk to your midwife or GP so that you can be seen sooner than three months.

If you had a 4th degree tear, you will be referred to the uro-gynaecology clinic three months after having your baby. If you have really troublesome problems, talk to your midwife or GP so that you can be seen sooner than three months.

What about having another baby?

There is no reason to suggest having a vaginal birth next time is not possible. You will be able to discuss your options for future birth (vaginal delivery or planned caesarean section) with an obstetrician early in your next pregnancy. Your individual circumstances and preferences will be taken into account. Please book with your midwife early in the next pregnancy, so that you can be referred to be seen in Antenatal clinic by a Consultant Obstetrician to discuss your options for delivery.

Commercial umbilical cord blood collection refers to a service offered by commercial companies to harvest and store stem cells following family requests even though there may be no medical indication.

A significant number of private companies are now heavily marketing their cord blood services through GP surgeries, antenatal clinics and direct contact with the public. There is a cost and requires a third person to collect umbilical cord blood in the third stage of labour in the provided container. This is then sent to the company for the harvesting and storage of stem cells.

The major clinical use of cord blood has been for life threatening conditions such as cancers of the blood. Cord blood contains the stem cells which are responsible for producing all the blood cells in the body. These cells can be used successfully as an alternative to bone marrow for transplants. Some families are at particular risk from rare inherited disorders. For these women cell banking may provide an easier route to a cell match that may be needed in their family. Under these circumstances arrangements can be made by professionals through the NHS Cord Blood Bank (NHS CBB) for their blood to be collected and stored.

At delivery

If the Clinician feels at any time that cord blood collection maybe detrimental to the wellbeing of the mother or baby the collection service will not be available. Examples of this would be premature birth, Emergency caesarean section or maternal haemorrhage.  There will be no change in how the delivery of the placenta is managed (3rd Stage) and any samples should be only be taken from a delivered placenta.

The responsibility for the quality or quantity of the sample collected or for delays in transportation or storage will lie with the external company providing the service.

If you wish to take the blood yourselves using a DIY kit, midwives will not be able to assist in this procedure. You will be given the delivered placenta as soon as it is practical to do so and the midwife will leave you to manage this procedure independently.

Please confirm with your midwife where you need to dispose of the needles you have used

Policy for Cord Blood Collection for Stem Cells at North Bristol NHS Trust

The Royal College of Midwives (2002) and the Royal College of Obstetricians (2006) do not support the commercial collection of cord blood for low risk families due to the current lack of research evidence to support the procedure. This service of commercial cord blood collection for stem cells for low risk families is therefore not offered at North Bristol NHS Trust. If parents still decide to go ahead with this procedure the maternity unit request that the parents will provide a trained third party to obtain the sample. The advice and training for this should be available from the private company offering the service. When there is medical indication for cord blood collection due to a family history of life threatening conditions such as cancers of the blood, please discuss this with your obstetrician who will be able to refer you appropriately for arrangement and advice of the process for collection. A third party will be requested to be available from them to perform the cord blood collection. The midwife will be unable to assist in this process following your baby’s birth.

For RCOG advice on Cord Blood banking and Storage (RCOG 2006) visit at www.rcog.org.uk

A major part of midwifery care during labour is listening to and recording your baby’s heartbeat to help identify if there are any problems.

Most babies come through labour without any problems, but there are a few babies who run into difficulties. The best way of finding out which babies are having trouble is to listen to every baby’s heartbeat regularly throughout labour.

What is the midwife listening to?

The normal range for the rate of the baby’s heartbeat is between 110 and 160 beats a minute, although this can be higher or lower without meaning that the baby is in difficulty. The variation in the baby’s heart rate may be caused by the womb contracting, which affects the blood flow to the placenta (afterbirth). This is normal and most babies cope without any difficulty.

If your baby is not coping well, this may well be reflected in the pattern of their heartbeat.

As well as monitoring your baby’s heartbeat, your pulse (heartbeat) will also be checked in order to tell the difference between them.

How is my baby’s heart rate is listened to and monitored?

Your baby’s heartbeat can be listened to in a number of different ways, either at regular intervals (intermittent auscultation) or continuously (electronic fetal monitoring (EFM).

Intermittent auscultation - is where your baby’s heart beat is listened to at regular intervals with either a pinard or a small hand-held ultrasound device called a Doptone. If you are healthy and have had a trouble free pregnancy this is the recommended way of listening to your baby’s heartbeat during labour. When pregnancy and labour are uncomplicated, research has now shown that the use of continuous Electronic fetal monitoring does not improve the outcome for the baby.
Midwives and doctors listen to your baby’s heartbeat over a full minute, every 15 minutes once your labour is established and then more frequently as you get nearer the birth.

Continuous Electronic Fetal Monitoring (EFM) - is where your baby’s heart beat is listened to continuously using a machine that produces a paper printout called a cardiotocograph (CTG). The EFM machine works by having two pads (transducers) each about the size of a drinks coaster, held in place on your abdomen with two elastic belts. One is placed towards the top of your abdomen, so that is lies over the upper end of your womb(uterus) to pick up your contractions; the second one will be positioned on your abdomen, over the area where your baby’s heartbeat can be heard best.

The information received by the transducers is converted by electronics within the machine to produce a graph. EFM using the two external transducers is a non-invasive method. Sometimes, for reasons which would be explained to you, the baby’s heart beat is picked up by using a small electrode which is placed onto the baby’s head, and attached by a thin wire to the machine, and this would mean you would need to have an internal (vaginal) examination in order for this to happen.

Which method will be used?

If, when listening to your baby’s heart beat with a pinard stethoscope or doptone device, your midwife or doctor thinks there may be a problem, they may recommend that you change to EFM. If you are in labour at home, you will need to transfer to the Central Delivery Suite for EFM.

If you have had problems during your pregnancy and the midwives or doctors have some concerns about how your baby will cope with labour, they may recommend the use of EFM as soon as you have regular contractions and your labour is becoming established. National guidelines (NICE - National Institute for Clinical Excellence) recommend the use of EFM in the following circumstances:

• Your baby (from external assessment) seems smaller than expected
• You have high blood pressure
• You are expecting twins or triplets
• You had a caesarean birth with any of your previous pregnancies
• Your labour has been induced for any reason on this list.
• Your baby is overdue (more than 42 weeks)
• Your baby is premature (before 37 weeks).

Other factors that may affect your decision about which type of monitoring to choose are the method of pain relief (intermittent or continuous use of EFM is recommended with an epidural), or a ‘drip’ (infusion into a vein) to start (induce) or speed up labour. In these instances your midwife will recommend EFM.

EFM will also be recommended in the following circumstances:

• You have a health problem such as; Diabetes; problems with your heart or kidneys or infection
• Your baby is breech presentation (going to be born bottom first).

What are the benefits and risks?

Listening to your baby’s heart beat in labour is standard normal practice and is for the benefit and wellbeing of you and your baby. In certain situations, as described earlier, the extra information provided by EFM may be appropriate to further monitor your baby’s wellbeing. EFM in itself has no known risks, but when internal EFM is used there may be a very small risk of infection. EFM may also restrict your mobility in labour which may not be helpful, although there is no need for you to be immobile.

If your baby is being monitored by EFM and it shows a problem with the baby’s heartbeat, you may be offered a test called fetal blood sampling. In this test a small sample of blood is taken from the baby’s scalp and tested for the amount of oxygen. This test is performed during an internal examination and it is recommended as being the most accurate way of detecting whether your baby is in difficulty. The doctors can use this information to decide whether your baby needs to be delivered by caesarean birth or it may prevent an unnecessary caesarean birth.

Do I have a choice on the type of monitoring?

It remains your choice as to what kind of monitoring you have during your labour. It might be helpful to consider:

• The hand held doptone can be used whatever position you are in; you can therefore move around as much as you like during labour and it can also be used if you are labouring in water.
• EFM will limit your movement, although you can stand up or sit in a chair, but you may need to ask your midwife for assistance. However, there are electronic monitors available, sometimes, which use a “telemetry” process to pick up the baby’s heart rate and your contractions and this means you will be able to be more mobile e.g. walk away from the monitor, as there will be no leads coming from the transducers around your abdomen (tummy).

If you would like to know more about monitoring your baby’s heart beat during labour please discuss with the midwife.

What affects my breathing in labour?

• Excitement
• Pain
• Tiredness
• Worries/anxiety
• Fear
• Contractions.

All of these responses may be experienced during labour. These feelings may change your normal breathing pattern in either of these ways:

• Breath holding
• Panic breathing (hyperventilation).

These may make you more tense, frightened and anxious.

Breathing for the first stage of labour

Contractions are felt as the uterine muscles tighten and the muscles of the cervix relax and open. Some may be experienced as backache, aching in legs or similar to deep cramp of period pain. It is important to maintain a regular breathing pattern to assist the uterus by:

• Relaxing
• Listening to your breathing
• Use a phrase with your breathing.

‘Sigh Out Slowly’ (SOS)

‘Breathe in through my nose and sigh out through my mouth’ (in 2,3 out 2,3).
Breathe in through your nose and imagine, as you sigh out, that you are causing a candle flame to gently flicker.

You may find it useful to greet the contraction with a sigh and end with a sigh.

You and your birth partner

Practice breathing together, before the birth.

You

• Imagine a contraction is arriving
• Greet the first discomfort with a sigh
• Relax and breathe through the pain
• End with a sigh.

Your birthing partner

• Can time your breathing for you, to practice the length of contraction
• Can learn to breathe at the same rate as you
• Can help to remind you of a phrase if you are using one for labour
• Can help you to concentrate on your breathing and relaxation throughout labour.

Breathing and relaxation through a contraction will help release endorphins (the body’s own natural pain reliever) and ease your discomfort.

Breathing for second stage of labour

During the second stage of labour, you need to use your breath control to help push your baby out. Work with your body, listen to what your body is telling you. Your midwife may feel she can help you with this. Try to relax your pelvic floor muscles and not hold your breath while pushing.

As the baby begins to emerge, stretching the perineum, the midwife may ask you to stop pushing. Panting can sometimes help you with this.

Either slow panting or gentle blowing (just hard enough to make a candle flame flicker) will allow the baby to emerge slower and the midwife will be able to control its arrival whilst trying to avoid tearing.

Body Mass Index (BMI) is a measure of your height and weight and indicates if you are overweight. Pregnant women with a BMI over 35 are at higher risk of complications than those with a normal BMI (20-25).

However, with careful planning and discussions with your midwife, obstetrician and anaesthetist these risks can be kept as low as possible. We need your help to do this and we might suggest certain things. 

If your BMI is over 50 we will book you an appointment with a consultant anaesthetic doctor to discuss any concerns you or we might have. We will aim to do this in the final few weeks of your pregnancy before you go into labour.

If your BMI is over 40 but less than 50 an anaesthetic doctor will visit you when you come into Southmead Hospital in labour. If you wish to see an anaesthetist earlier in your pregnancy you are very welcome to ask for an appointment in antenatal clinic and in some cases, your obstetrician may advise an appointment.

Is there anything I need consider?

Women who have a high BMI have as much as twice the risk of needing a Caesarean Section delivery of their baby and this may need to be done as an emergency for the birth of their baby. A high BMI can cause problems when you have a general anaesthetic (go to sleep) for an operation. In most cases it is safer for you to have an epidural or a spinal block if you need a Caesarean Section birth. This means an injection is given into your back to make your lower body numb.

You are awake for the operation and this has many advantages for you and your baby however, making you numb in this way can be difficult if you have a high BMI. It may be harder to find the correct place to put the needle in your back than if your BMI was lower, and sometimes it is more difficult to get the numbness to work straight away.

There are times when we need to deliver your baby as quickly as possible. If you have already had an epidural put in during your labour, and it is working well, we can often use it to give very quick anaesthesia (numbness) for a Caesarean birth, or if we need to deliver your baby using forceps or ventouse (suction cup). This cuts down delays and reduces the chance of you needing to have a general anaesthetic (go to sleep) in an emergency.

For this reason, if your midwife or obstetric doctor feels that your labour is not entirely straightforward, we normally suggest that you should think about having an epidural sooner rather than later in labour. This allows the anaesthetist more time to put it in and to make sure it is working well for you.

Can I eat during labour?

We will give you medication to reduce the acid in your stomach during your labour. We strongly recommend not eating any food or having fizzy drinks when you are in labour. Water and sports isotonic drinks are much safer. We suggest that you bring a couple of bottles with you when you come in to hospital in labour.

What are the risks of blood clots/DVTs?

From the start of pregnancy you have been at a higher risk of getting a blood clot in your legs. Whilst you are moving around your risk is lower but during labour, and in the few days after your baby is born, you may be in bed a lot more.

To reduce the risk of clots we may need to give you:

• Elasticated stockings
• Heparin injections once or twice a day to thin your blood for 7 days after the birth. We will teach you and/or your partner how to do this, if appropriate.

For more information visit www.nhs.uk/conditions/pregnancy-and-baby/pages/overweight-pregnant

During pregnancy your baby’s brain is developing and growing very quickly. While you are pregnant you can help your baby’s brain to grow as you start to get to know your baby. Here are some suggestions:

• stroking your bump
• talking to your baby/singing/playing music that you like
• thinking about your baby and talking with your partner and other close family about your baby.

Try and take a little bit of time each day when you can sit and talk to your baby. When you do these things you release hormones that help healthy development and growth of your baby’s brain. 

If you have any questions about feeding your baby please talk to your midwife. If you have any particular concerns about feeding your baby your midwife can refer you to the infant feeding specialist midwife.

For more information:

• Building a Happy Baby www.unicef.org.uk
• Off to the best start - information about feeding your baby 

Community Midwives and Maternity Support Workers (known as MSW’s) will care for you during your pregnancy and in the early days when you are at home with your baby. The MSW’s work under the direction of the Community Midwives who coordinate your care and they work together to support you until your baby is approximately 10 days old, when your care is then transferred to a Health Visitor.

The Community Midwifery teams are based at a variety of places such as GP surgeries, Health Centres, Clinics or Children’s Centres. Where you see yours will depend on where you live. 

Maternity Notes

Once you have completed our online self-referral form, a member of the booking team will be in contact with you to set up access to your maternity notes. At NBT we use digital notes called Badger Notes, which can be accessed on the web or an app on your phone. Find out more about Badger Notes.

Contacting Your Midwifery Team

For general advice about your pregnancy, your baby or your appointments please contact your Midwifery Team. Monday to Friday calls will be dealt with within 48 hours. The telephone numbers can be found within the ‘hospital contacts’ tab of your Badger Notes or by visiting the Contact Maternity Services page on our website. Remember; you can also get general health advice from your GP service or NHS 111.

Many parents choose to support Maternity Services at Southmead through fundraising or donations to mark the birth of their child or as a thank you for the care they received.

Fundraising and donations to maternity through Southmead Hospital Charity contribute to projects like these which have already made a huge difference to mums and babies.

Improving facilities - improving labour and post-labour wards create better environments for mums and babies. Last year the charity funded a £120,000 new family room. New equipment like birthing pools and ongoing general refurbishments are now needed.

Balloon Mural - Since 2016, our balloon mural has taken pride of place in the Mendip Ward with hundred of families adding a balloon to celebrate the arrival of their children in return for a donation to maternity services. Our Charity is planning to refresh and improve its appearance to encourage more families to join the mural and more donations that will support parents, babies and the staff that care for them. If you're an existing supporter and would like to know more about the plans, please get in touch with Southmead Hospital Charity on southmeadhospitalcharity@nbt.nhs.uk. We hope to welcome new families to the mural in early 2024, with more information coming soon. 

Visit our charities website to find out more about how donations support maternity services and our hospitals.

You can donate online to support maternity services or call the Charity team on 0117 414 0170.