Royal College of Midwives President says many are missing training on the anatomy of the skin

20th December 2017

In category | Blog

The skin is the largest organ in the body yet there is little consideration to the importance of this in generic training for maternity health professionals.  Anatomy and physiology is certainly not taught in the generic way that was traditional in nurse, midwifery and medical training programmes back in the 1980’s.  Yet with all of our advances in health care there is some very basic information that can benefit the health professional and improve care for women.

Bio-Oil has collaborated with industry experts to produce information for midwives on the skin changes that occur during and after pregnancy including Stretch marks and scars such as C-section scars, ‘Guide to Skin and Body Changes During Pregnancy for Midwives’. However, it is important that health professionals understand the skin as the organ that it is, and let us give it the attention it deserves as the largest in the body:

Useful facts about skin you need to know:

  • The skin is about 2mm thick
  • It weighs about 6lbs in total
  • Purpose of it is to protect from light, heat, injury and infection
  • It regulates the temperature of the body
  • Is a sensory receptor
  • It stores water, fat and vitamin D
  • Is part of controlling the immune system
  • There are 3 layers which include
    • Epidermis – outer layer
    • Dermis – under the epidermis
    • Subcutis or hypodermis – fatty 3rd layer

If we know the value and purpose of the skin then we appreciate how this organ will be exposed to trauma and harm during different challenges present such as pregnancy or the menopause.

Epidermis

The epidermis is made up of about five sublayers; these layers constantly produce new skin cells that allow the skin to regenerate itself. The life cycle (replacement) of skin is around 28 days. Within the epidermis are vital protective components such as melanocytes (producing skin’s pigment). These are; melanocytes, Langerhans’ cells (immune receptors), Merkel cells (‘touch’ cells allowing skin to feel touch) and sensory nerves.

Dermis

The second layer of skin is the dermis and is the thickest part; it actually constitutes about 90% of the skin in totality.  The dermis is largely responsible for regulating the body temperature and supplies the epidermis with fluid and nutrients.  This is where vital structures such as the following are found;

  • Blood vessels – deliver fluid, oxygen and important nutrients but also take away waste products
  • Lymph vessels – destroy organisms that are likely to infect or invade the body through the skin
  • Sweat glands – eccrine and apocrine. Eccrine glands cover the majority of the skin allowing body heat to reduce by excreting fluid.  Apocrine glands are found only in the armpits and pubic region – encourage the growth of healthy bacteria for protection.
  • Hair follicles –is a tube surrounding the hair, with a strong blood supply bringing nourishment to the hair shaft
  • Sebaceous glands – are secreted everywhere on the body except the palms of the hands and soles of the feet. They excrete a natural oil called sebum that is a natural moisturiser of the skin and keeps the skin supple and smooth; there are about 3 million of these. Sebum together with sweat forms what is called ‘acid mantle’, which is a natural barrier protecting against germs and bacteria entering the skin.
  • Nerve endings – act as receptors to give the skin information such as when it is cold the nerve receptors will induce a shiver and this generates heat to the skin.
  • Collagen and elastin – collagen is a thick, strong protein that gives the skin its resilience against wear and tear holds muscles in place. Collagen is produced at the site of injury or a wound to try repair tissue and ‘glue’ the skin back together – which is known as scarring. It also bind water in the skin to keep it hydrated. However, elastin is another protein allows the skin to stretch and spring back to its original state.

Just like the epidermis the dermis layer is made up of two sublayers:

The Papillary Layer – is the upper layer holding main skin structures such as vessels, glands and nerve endings, controlling the blood flow and allowing temperature regulation and controls the blood flow and allows temperature regulation.

The Reticular Layer – is the thicker lower layer and strengthens the skin providing structure to support hair follicles and glands. This layer contains a meshwork of collagen and elastin fibres enabling movement and strength of the skin.

Subcutis

The final and lower layer of the skin is the subcutis this is made up largely of fat and connective tissue.  The amount varies from person to person and the main function is to provide ‘cushioning’ between skin and muscles and bones and protection to the inner organs, insulate for heat regulation and is a store for energy reserves.

In summary:

Phew, who would have thought that the skin would be so complicated and intricate. Makes it worthwhile understanding the physiology so we can help women in our care.

There are many benefits that midwives and other HCP can pass over to women during their pregnancy and early postnatal period that will be invaluable.  This is a simple as telling women to wear loose and fewer clothing as they are likely to find that they feel hotter and want to cool down.  This is largely due to the increased layer of subcutaneous fat that is being stored for breastfeeding but also the increase in circulating fluid ensuring the uterus is well supplied with rich nutrient packed blood.

Warning women about exposure to the sun

During pregnancy women produce a higher level of melanin which is the hormone that increases melanocyte (pigment cells) production. This causes hyperpigmentation of the skin or tanning. However some women find that although they do not over expose themselves to the sun they still have increased freckles, skin markation and sometimes something across the face called a chloasma (dark patch), which is a form of hyperpigmentation. It can be found anywhere on the body but is often seen as a butterfly shaped dark mark across the cheeks and nose. The reason for the hyperpigmentation is the fact that melanocyte-stimulating hormone is increased during pregnancy causing temporary pigmentation – it often disappears after pregnancy. With this in mind it’s important that pregnant women use an SPF at all times when being exposed to sun. The reason this hormone is increased is thought to be connected to the increased anti-inflammatory response and also the increases in aldosterone production which controls fluid balance at the time of changes to the woman’s circulating fluid volume.

The reason for the hyperpigmentation is the fact that melanocyte-stimulating hormone is increased during pregnancy causing temporary pigmentation – it often disappears after pregnancy. With this in mind it’s important that pregnant women use an SPF at all times when being exposed to sun.

Resources for midwives:

Bio-Oil Professional has several free resources for midwives on the topic of scarring and stretch marks, free to download:

Resources for your patients:

 

Kathryn Gutteridge

This article was written by: Kathryn Gutteridge

Kathryn is currently President of the Royal College of Midwives and has worked with childbearing women for the past 28 years. During that time she has supported maternity services and women as both a psychotherapist and midwife. She is currently involved in the Pregnancy Psychological Wellbeing Clinic at Sandwell & West Birmingham Hospitals NHS Trust, which supports anxious and fearful childbearing women.


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