Hegenberger Medical, Author at Hegenberger

Living with faecal urgency: A post-vaginal delivery guide

February 20, 2023 3:08 pm Leave a Comment

Blog Introduction: After having a baby, there is so much to learn. From nappy changing and feeding to knowing when it’s time to call the doctor—there are a lot of new skills and information to take in. One thing that many mothers don’t think about is faecal urgency. This is especially true for those who have had a vaginal delivery because of the changes that occur in the pelvic floor muscles afterward. Let’s look at what you need to know about living with faecal urgency post vaginal delivery. Off course this is not a routine side effect of vaginal birth but a rare usually manageable/treatable one.

What Is Faecal Urgency?

Faecal urgency is an intense urge to defecate (have your bowels open) that can come on suddenly and cannot be ignored or delayed for very long. It is caused by weakened pelvic floor muscles and can be very uncomfortable and lead to real anxiety. It can also lead to involuntary loss of bowel control if left untreated, which can be embarrassing and stressful for new mothers who are already dealing with a lot of change.

How Can I Manage Faecal Urgency?

The first step in managing faecal urgency is understanding why it’s happening in the first place. The biggest factor is weakened pelvic floor muscles due to childbirth—especially if you had a vaginal delivery. These muscles help keep our bowels closed until they are ready to open and release waste, but after pregnancy, they are stretched out and may not work as well as before.

To manage faecal urgency, it’s important to do some exercises specifically tailored for strengthening your pelvic floor muscles. There are lots of resources online (and your midwife should be able to provide some guidance) some apps like the NHS “squeezy” app will send notifications to your phone to remind you to do a set of exercises, they will help you identify the best exercises for your needs and how often you should be doing them in order to see results quickly. Additionally, eating high-fiber foods like fruits, vegetables, nuts, seeds, and whole grains can help reduce symptoms associated with faecal urgency such as constipation or diarrhea because they make it easier for waste material to pass through your system naturally without straining or pain during elimination. Perhaps keep a food diary and see if there is a link between what you are eating and the faecal urgency you are encountering.

Conclusion:

Living with faecal urgency post vaginal delivery can feel overwhelming at first—but it doesn’t have to stay that way! By understanding why this condition happens and taking proactive steps like exercising your pelvic floor muscles regularly and eating high-fiber foods, you’ll be able to manage symptoms more effectively so that you can get back to focusing on enjoying life with your new little one! Remember this symptom is very unlikely to lats forever.

The information found anywhere on this website, including but not limited to text, graphics, images and any other material therewith is for information purposes only. No material on this website is intended to be a substitute for professional personalised medical advice, diagnosis or treatment. By providing the information contained herein we are not diagnosing, treating, curing, mitigating or preventing any type of disease or medical condition. Always seek the advice from a registered health care professional if you have any questions regarding any medical concerns or conditions. Do not disregard professional medical advice or delay in seeking it because of something you have read on this website.

Perineal massage for a smooth delivery!

February 8, 2023 11:24 am Leave a Comment

You’ve heard the horror stories of episiotomies, stitches, and tearing during childbirth. But there may be a way to reduce your risk of vaginal tears during delivery: Perineal massage. Read on to learn more about this method of promoting natural birth.

What is Perineal Massage?

Perineal massage is the practice of massaging the area around the vagina (the perineum) prior to giving birth in order to prepare it for stretching. The massage can be done using oil or lubricant and is usually done with two fingers. It can be done in the comfort and privacy of your own home by yourself in the weeks leading up to the expected date of delivery of your baby.

Does it Work?

Studies have shown that perineal massage can reduce the risk of tearing or needing an episiotomy during childbirth. One study found that women who received perineal massage had a 24% lower risk of severe tears than those who did not receive massage, while another found that the risk was reduced by 32%. However, it’s important to note that perineal massage won’t guarantee that you won’t tear; some women still do despite having received massage.

How do I Do Perineal Massage?

If you decide to give it a try, here are some tips for performing effective perineal massage: • Start with clean hands and use oil or lubricant on your fingers, these do not have to be expensive you could even use olive oil or almond oil• Use both hands and start massaging from side-to-side instead of up and down • Slowly increase pressure as you go • Hold each spot for 10 seconds before moving on • Breathe deeply throughout • Relax as much as possible

Conclusion: Performing perineal massage is no guarantee against tearing during childbirth, but it does seem to help reduce the risk of severe tears or needing an episiotomy. If you’re considering giving birth naturally, then adding perineal massage into your routine may be worth looking into! It’s best to speak with a midwife or healthcare provider beforehand so they can guide you through the process properly. Good luck!

Hegenberger Medical launch in Portugal!

December 20, 2022 12:18 pm Leave a Comment

Hegenberger Medical is pleased to announce that Aviquímica has been appointed as a strategic Enterprise Partner and the exclusive distribution partner of the Hegenberger Retractor in Portugal.

The Hegenberger Retractor, invented by our Founder Danish midwife Malene Hegenberger, is a unique, innovative and award-winning device, which transforms postpartum exploration and suturing by providing a clear view of the vaginal walls and perineum, improving outcomes for women with postpartum tears. The Hegenberger Retractor is the first innovation in this field of obstetric practice for over 150 years.

Aviquímica is a leading company in the distribution of medical, surgical, hygiene, patient comfort and safety and laboratory products to Portuguese healthcare facilities. With more than 50 years providing innovative and quality healthcare solutions, Aviquímica is featured amongst the businesses selected as suppliers to the Health Department of Portugal.

Ricardo Barros, Director said, “It is my belief that the use of Hegenberger Retractor will represent a significant breakthrough in episiotomy suturing and perineal trauma repair. Aviquímica is most proud in making available a innovative tool that not only facilitates clinical intervention of healthcare professionals, but above all improves patients recovery and wellbeing.”

For further information about the Hegenberger Retractor in Portugal, orders or training support please contact Aviquímica’s customer services team on (+351 217121940), send an email to (geral@aviquimica.pt) or visit their website (https://www.aviquimica.pt/pt).

Hegenberger Medical study published in MIDIRS Digest December 2022 issue

December 16, 2022 12:51 pm Leave a Comment

We’re delighted to announce that another of our clinical studies has been published in the latest issue of the MIDIRS Midwifery Digest (Dec 2022, volume 32, number 4).

In the December issue of the Midwives Information & Resource Service (MIDIRS) quarterly journal Darya Kozlyk and Malene Hegenberger analyzed qualified midwives’ perceptions of our Hegenberger Retractor for perineal repair following online clinical training.

We were so pleased with the study’s positive results! Their findings included:

97% of midwives were extremely positive or somewhat positive about the Hegenberger Retractor.
Midwives believed that the Retractor was an appealing, unique and clinically relevant device.
High likelihood of uptake in use if available in the clinical environment to facilitate postpartum perineal repairs.
Midwives identified benefits of using the Hegenberger Retractor such as simplicity of use, improved exposure for perineal diagnosis and repair, enablement of hands free work and improved safety such as perceived reduced risk of needlestick injury.

Want to read the study for yourself? Then click the link below:

Click here to download

Hegenberger Medical launch in Canada!

December 14, 2022 12:08 pm Leave a Comment

Hegenberger Medical is pleased to announce that AMT Surgical has been appointed as a strategic Enterprise Partner and the exclusive distribution partner of the Hegenberger Retractor in Canada.

The Hegenberger Retractor, invented by Danish Midwife Malene Hegenberger, is a unique, innovative and award-winning device, which transforms postpartum exploration and suturing by providing a clear view of the vaginal walls and perineum, improving outcomes for women with postpartum tears. The Hegenberger Retractor is the fist innovation in this field of obstetric practice for over 150 years.

AMT Surgical is a leading medical distributor with more than 25 years’ clinical experience and a deep knowledge of the market, being the largest distributor of Electrosurgical accessories in Canada. Currently conducting business with more than 400 hospitals in the Canadian market, AMT Surgical solely focuses on careful consultation with their customers to determine the optimum balance of patient safety, clinical performance, ease of use and cost effectives.

Marcus Baiano, National Sales Manager, said “We are very pleased to be partnered with Hegenberger Medical and feel that the Hegenberger Retractor will bring significant value to Canadian Healthcare and will improve patient outcomes across the country.”

For further information about the Hegenberger Retractor, orders, or training support, please contact AMT Surgical’s Customer Services Team on 1-888-803-6799 or alternatively, email orders@amtvantage.com.

Myth-busting with Marie Louise: Giving birth

October 19, 2022 10:30 am Leave a Comment

To mark the start of our new partnership with The Modern Midwife, midwife and author Marie Louise explores (and busts) three of the biggest myths surrounding childbirth:

– Pain and planning: Factoring pain into birth plans

– Do as you’re told: The importance of speaking up

– Go with Hollywood: What comes next after waters break

For straightforward advice on how to plan for the best birth experience, Marie Louise is an excellent choice. Visit https://hegenbergermedical.com/mothers/ for details of learning content and practical advice including videos and factsheets developed especially for the new Hegenberger Medical – The Modern Midwife collaboration.

Giving birth is one of the biggest events in anyone’s life, and its natural to feel anxious and look for sources of information on the topic. This month we asked The Modern Midwife and one of the Hegenberger Medical’s Clinical team members Marie Louise what some of the most common preconceptions are that she finds when supporting expectant mothers in maternity departments. Here’s what she said:

MYTH 1: Birth is going to hurt!

REALITY: Although many people believe that birth is going to hurt, this isn’t necessarily true. Yes pain is common during birth but it is possible to have a positive and powerful birth experience. We associate pain with negative consequences but there is positive pain too. We’ve all experienced pain or discomfort during a hard workout, a particularly good stretch, etc. This doesn’t mean that it’s a bad experience and something we’d never want to do or participate in again. Lots of women describe birth in a similar way, it’s a powerful and amazing experience with a rush of endorphins afterwards. As with all things, proper planning can lead to better outcomes. Just like planning a route for a jog and putting on the correct trainers, planning your birth and ensuring the right tools and techniques are available will lead to better experiences and positive outcomes. There is so much more to birth than pain, there is joy, support, care and empowerment!

MYTH 2: It’s best to do as you’re told / medical professionals always know best

REALITY: All patients can and should seek advice, support and guidance from trained medical professionals. However, and as a medical professional this may seem counterintuitive for me to say, we aren’t the experts in your specific body. No one knows your body or preferences like you. That’s why it’s important to make decisions based on what’s right for you and your personal circumstances. As medical professionals we recognise that there is no one rule that fits everyone, we’ll work with you and share best practice, information and guidance but ultimately you’re the decision maker in the room for your body. Its ok to request more information, to decline options, and to ask questions. I’d encourage all patients to find out more and work with your medical team so they can deliver the best possible care for you and your new baby.

MYTH 3: You’ll give birth soon after your ‘waters go’

REALITY: I’m sure that we can all agree that Hollywood has crept into many aspects of life and I’m afraid to say that the Maternity ward is no different. Despite how birth is portrayed in the movies or on TV, when a mother’s waters break (the rupture of the membrane) this doesn’t automatically mean that you need to rush to your midwife or call them out to you. There are some standard things that we recommend because they are important, such as noting the time, colour, smell and your baby’s movements, but unless you identify something abnormal there is no need to grab your baby bag and head to Hospital. Relax! Sometimes your waters will go and you won’t experience labour for several more hours. In fact a study that we often quote to patients found that only 10% of mums will go into labour within 24 hours of giving birth…! I’d recommend discussing your plan with your midwife or healthcare professional regarding your waters breaking, and if in doubt its ok to ask.

A clinician’s review of perineal tear repair in the UK

June 20, 2022 2:00 pm Leave a Comment

Where have we come from and where are we going?

Author: Darya Kozlyk, Midwife at University College of London (UCLH) Hospital. PhD Candidate in Maternal Medicine at UCL. Qualified midwife since 2015.

Around 85% of women who have a vaginal birth will sustain some degree of birth-related perineal trauma and of these around 70% will need perineal suturing, usually within an hour of the birth¹. Critically, perineal trauma requires accurate examination, classification and adequate repair to avoid lifelong adverse consequences for the woman’s physical, sexual and psychological health².

2003 Milestone Moment

The NHS supports approximately 350,000 women who sustain perineal trauma every year². Yet despite this perineal repair via perineal suturing was not systematically incorporated into routine clinical practice in the U.K³ until the results of a seminal randomised control trial in 2003⁴ were published which found that repair leads to improved healing. This, along with Cochrane systematic reviews recommending continuous suturing using absorbable sutures (which don’t need to be removed postnatally), has seen the practice of perineal repair firmly incorporated into the National Institute for Health and Care Excellence (NICE) guidelines⁵.

Today: Room for Improvement

Despite the significant improvements new guidelines have led to, there remains significant areas for improvement. For example, second degree perineal tear repair is the most common intrapartum surgical procedure yet studies have shown considerable gaps and disparities in the methods used in clinical practice⁶. Studies of UK-based qualified midwives show that only 39% feel that their training was adequate, that 37% had no hands-on training prior to undertaking their first repair⁷ and only 6% of midwives used evidence-based suturing methods to repair all layers of the perineum⁶. To address this knowledge gap the Perineal Assessment and Repair Longitudinal Study (PEARLS)¹provides an interactive educational package that aims to improve evidence-based practice and is available to all Midwives through the Royal College of Midwives’ I-learn platform⁷.

Despite the advances in training, current standard practice for postpartum suturing inherently limits every clinicians’ ability to comply with evidence-based best practice. Today’s standard guidelines require the suturing clinician to digitally retract vaginally tissue to locate the apex, classify the degree of trauma and maintain this position for the duration of the procedure. This puts the clinician at high-risk of needle stick injury, hinders the quality of repair and increases the risk of inadequate repair.

The Future of Perineal Repair

The Hegenberger Retractor for perineal repair is the next step in suturing best practice for clinicians and their patients.

Designed to work in conjunction with PEARLS Training Package, Obstetric Anal Sphincter Injuries (OASIs) Two Bundle⁸ and NICE clinical guidelines⁵, it allows suturing clinicians to perform repairs according to evidence-based practice and using both hands for the duration of the procedure. Emerging international data from clinicians shows the retractor improves exposure and access for the suturing clinician, provides a safer, more ergonomic environment to perform routine repairs and complex OASIs and aids compliance with evidence-based suturing practice.

References:

Ismail KM, Kettle C, Macdonald SE, Tohill S, Thomas PW, Bick D (2013). Perineal Assessment and Repair Longitudinal Study (PEARLS): a matched-pair cluster randomized trial. BMC Medicine 11(209). https://doi.org/10.1186/1741-7015-11-209 [Accessed 14 June 2022].
NHS Digital. NHS maternity statistics, England 2019-20. 2020. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2019-20 [Accessed 15 June 2022].
Lundquist M, Olsson A, Nissen E, Norman M. Is it necessary to suture all lacerations after a vaginal delivery?. Birth. 2000 Jun;27(2):79-85. Available at: https://doi.org/10.1046/j.1523-536x.2000.00079.x [Accessed 20th July 2022].
Fleming VE, Hagen S, Niven C. Does perineal suturing make a difference? The SUNS trial. BJOG: an international journal of obstetrics and gynaecology. 2003 Jul 1;110(7):684-9. Available at: https://doi.org/10.1016/S1470-0328(03)02353-X [Accessed 20th July 2022].
National Institute for Health and Care Excellence (NICE) (2014). Intrapartum care for healthy women and babies [Last updated 21 February 2017]. https://www.nice.org.uk/guidance/cg190 [Accessed 25 May 2022].
Bick DE, Ismail KM, Macdonald S, Thomas P, Tohill S, Kettle C. How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC pregnancy and childbirth. 2012 Dec;12(1):1-0.
https://doi.org/10.1186/1471-2393-12-57 [Accessed 14 June 2022].
Royal College of Midwives (RCM). MaternityPEARLS; Perineal Repair and Suturing. 2018. Available at: (Accessed 2^nd August 2022).
Royal College of Obstetricians and Gynaecologists (RCOG). OASI Care Bundle Project. 2020. Available at: https://www.rcog.org.uk/oasicarebundle [Accessed 20th July 2022].

Eureka! Inspiration for the invention of the Hegenberger Retractor

1:59 pm Leave a Comment

Author: Malene Hegenberger, practicing Clinical Specialist Midwife at Slagelse Hospital in Denmark and inventor of the Hegenberger Retractor. A certified Registered Nurse in Denmark (1998) and Certified Midwife in Norway (2002).

Innovation from clinical experience

As a midwife, it is essential to me that patients receive the best possible care. I have always enjoyed working in hospitals and healthcare environments and it is an important reminder for me that as a midwife I take care of a woman and their baby at a hugely significant moment in their lifetimes.

The satisfaction from performing a correct postpartum repair really makes my day. To finish off a vaginal delivery with the correct diagnosis, repair and normal (for the patient) looking vagina and external genital should be the standard expectation for all women. Yet, this can be very difficult to achieve. I have been fortunate enough to work as a nurse / midwife in the UK, Norway, Slovenia, Caribbean and the USA and found that the challenges facing midwifes and clinicians are universal.

For years I had difficulty inspecting, diagnosing, and managing my instruments, whilst keeping the trauma area dry of blood. I needed a third hand to hold aside the vagina and cause less manipulation for my patient, or a colleague to support during the procedure. All of this whilst continuing to look after the wellbeing and welfare of both mother and baby. I shared these experiences with my colleagues who related similar challenges and frustrations. Surely there was a better way? I researched best practice and devices to aid postpartum repair and found that despite the same issues occurring for clinicians worldwide, no one had yet solved the problem.

I wanted to.

Inventing a medical device

Mimicking an assistant, the Hegenberger Retractor is a device that helps midwives, doctors and clinicians. It enables them to suture most patients alone, without requiring additional colleagues. Once inserted into the vagina, it enables a better view of the tear for clinicians, enabling accurate diagnosis and optimal understanding of how to close the tissue and muscles in the best way for the patient. It also leaves both hands free, enabling correct suturing techniques using a needle holder and forceps, and this reduces the risk of needlestick injuries for me and my colleagues.

Lastly, I am especially proud of the role that the Retractor has in improving teaching conditions for the next generation of midwives, doctors and clinicians. It enables a greater understanding of the anatomy, visibility of different types of tissue and allows tutors and students to sit side by side and focus upon teaching and practice with both pairs of hands available, rather than a tutor simultaneously holding aside the vaginal walls, teaching and monitoring a student’s work.

The future

The Hegenberger Retractor is our first product, but my mission is to improve the care and information available for women’s pelvic and genital health globally. Change takes time, but I believe that our Hegenberger Retractor can directly contribute to increased levels of correct diagnosis and therefore correct suturing treatment. The consequences of inaccurate diagnosis have a long-term impact upon women’s physical, emotional and sexual health, and are now avoidable.

In a few years I hope that the Hegenberger Retractor will be available as standard across the globe and that suturing women has same prestige as other procedures we perform during pregnancy and labour.

I hope that my invention can contribute to improving wellbeing and care for women. Every woman has to live with a repair for the rest of her life and we should always keep that in mind.

Why is what comes after birth an afterthought? Time to give postnatal care the spotlight

1:59 pm Leave a Comment

Author: Marie Louise, Founder of the Modern Midwife and a UK Midwife since 2012 and Senior Midwife in Australia (2013-15)

Antenatal vs Postnatal care – mind the gap!

Growing and giving birth to another human being requires a lot of nutrition, energy and physiological changes. This includes changes to the cardiovascular system, blood volume increasing by 50%, the lungs changing shape and the loosening of ligaments leading to supported fetal growth, to name just a few. Mums are often left with some form of wound either due to a c-section or trauma to the perineum. Yet rarely do we prepare mums for this or talk about wound care afterbirth. Why is this?

If a mum goes on to breastfeed she needs to continue to share her body in many ways and makes around 600ml – 1200ml milk every 24 hours for her baby. Breastfeeding maybe a natural process but it does not come naturally to many mums as all maternity care providers know, mums need support, realistic expectations and a good understanding of normal newborn behaviour. Why isn’t more education and support provided?

What comes afterbirth often remains an afterthought. During pregnancy the focus is often on fetal surveillance, the pregnancy and birth preparation. Lots of mums are left wondering, why wasn’t I prepared for this? Sadly postnatal care is the aspect of maternity care that women in England are least satisfied with¹. Likely this will not come as a surprise for every clinician reading this, we have long been aware of the differences in antenatal and postnatal care.

Postnatal care internationally – how do approaches differ?

The approach to postnatal care differs widely throughout the world by both country and culture. Let’s explore some examples.

In Malysia, there’s real focus on the first six weeks following birth and nourishing the mum to support her healing and recovery.

Nearby in China there is something known as ‘the one month sitting’ where new mums aren’t expected to get out of bed and everything is done for them. Some clinicians would argue this is not ideal due to the risk of blood clots and that movement promotes healing, yet it’s interesting that postpartum care is embedded so firmly into the nation’s tradition and consciousness.

The ancient practice of Ayurveda in India is the world’s oldest holistic healing system and includes an approach for new mothers. The practice recognises the stress that birth can have on mums’ bodies and seeks to harmonise their vata energy with rest, warmth, food for their digestive system and nourishment.

Closer to home, mums in the Netherlands are given access to a Kraamzorg which is a unique form of postnatal care where a professional supports a new mum with daily recovery checks, a daily review of the baby (checking weight, temperature, etc.), supports (if necessary) with breastfeeding and teaches both parents about basic childcare. A Kraamverzorgende will even help with light household work such as laundry and cleaning of the household including the bathroom, toilet and mother and baby’s rooms to ensure a clean environment for the family and their newborn.

So what learnings can we take for the UK?

It’s important to consider different international practices and how they are supporting new mums when considering our approach to postpartum care in the UK.

Postnatal care has an important role in enabling a safe and positive transition to parenthood, especially for first time parents². The consequences of poor postnatal care may be especially problematic for first-time mothers, who need to develop parental confidence, new skills understanding of their body and their babies³. Research by Jenny McLeish revealed first-time mothers’ satisfaction with postnatal care and their confidence as new mothers were primarily influenced not by the extent to which their expectations were met but the varied extent to which their postnatal needs were met’¹.

Ultimately, McLeish concludes that rapid and responsive assessment of needs both antenatally and postnatally is the best possible course of action for mum and baby alike. Raising concerns with our senior colleagues and questioning processes that may not supporting mums is important. Our voices matter and we have a profound impact on new mothers’ lives.

As care providers we need to bring focus back to postnatal care, to offer solutions and push to promote and define postnatal care pathways. Let’s start here in the UK and put postnatal care back into the spotlight where it belongs.

References

First-Time Mothers’ Expectations and Experiences of Postnatal Care in England, Jenny McLeish, Merryl Harvey, Maggie Redshaw, … First Published September 17, 2020 Research Article in PubMed https://doi.org/10.1177/1049732320944141
Demott, K., Bick, D., Norman, R., Ritchie, G., Turnbull, N., Adams, C., Barry, C., Byrom, S., Elliman, D., Marchant, S., Mccandlish, R., Mellows, H., Neale, C., Parkar, M., Tait, P., Taylor, C. (Eds.). (2006). Clinical guidelines and evidence review for postnatal care: Routine postnatal care of recently delivered women and their babies. National Collaborating Centre for Primary Care and Royal College of General Practitioners.
Barclay, L., Everitt, L., Rogan, F., Schmied, V., Wyllie, A. (1997). Becoming a mother— An analysis of women’s experience of early motherhood. Journal of Advanced Nursing, 25(4), 719–728. https://doi.org/10.1046/j.1365-2648.1997.t01-1-1997025719.x

Author Archives: Hegenberger Medical