Wednesday, 16 February 2011

What do women want?

I've talked quite a lot about the kind of midwife that I want to be but the other day I was considering the kind of midwife that women want? I am in the unique position of knowing a variety of women, who have all had very different labours and experiences, positive and negative, so I took the opportunity to ask them just how they felt about their births and how they felt about the midwives involved in their care. The response was very mixed, as you'd expect but there were some common answers that seemed to run through their replies. The responses made for very interesting reading, and sometimes very emotional reading.

It came as no surprise that the women wanted to feel listened to; that they were more than just a number and treated as an individual. It's a well researched fact that women in labour have better outcomes when they receive one to one care and yet this doesn't appear to be happening for all women. Their are midwifery shortages throughout the UK which places a huge impact on the services that midwives are able to provide and the subsequent experience that women will get. Although it cannot be denied that staff shortages are not the sole reason that some women do not receive one to one care and despite listening skills being highlighted as an essential requirement for any midwifery student candidate, it appears that some midwives have lost the ability.

The vast majority of positive experiences were during labour and planned caesarean births and the women spoke of calm, reassuring midwives who kept them informed. There was disappointment spoken of, if a midwife who had been present for their care, had come to the end of her shift and a different midwife had taken over. Again I was reminded of the importance of one to one care and how much of a difference it made to women.

I was particularly sad to read that for most women the postnatal care, and in particular the breastfeeding support was declared to be awful. This is where there was frequent mention of a lack of staff, the staff that were there being in a rush because of the number of women they were caring for, coming across as uncaring and uninterested. It also seemed that whilst midwives had the knowledge about breastfeeding and support, they didn't have the time to spend with women supporting them.

Another factor in whether or not women had a positive birth experience, appeared to be their expectations of how things would be. I have heard it said many times that for the woman with the explicit birth plan, strict dos and don'ts of what they want, is a straight to theatre kind of woman. Whilst this is said very tongue in cheek, there can be a bit of truth in that statement - in particular for the first time mother. If you've not experienced it before, then how can you truly know what you'll need? If you aren't expecting labour to be hard work, then it's unlikely that a choice of no pain relief is going to work out. If you are expecting to jump straight back to normal following a Caesarean section, then you will get a bit of a shock.

There are no gold medals given out for childbirth and whether or not you use pain relief, whether you "manage" without an epidural, whether or not you give birth vaginally or your baby takes the sun roof! Yet I have heard many women speaking of feeling like a failure because things didn't go to plan.

My advice to women would be to be as open minded as you can be about pain relief, and positions and what you might need. It's good to know roughly what to expect but don't get fixed on a plan.

My advice to myself and any other aspiring midwives would be to always listen to women; to always remember the value of time and try wherever possible to provide one to one care, to keep women informed, be honest with them and let them know what is happening. When you can't spend time with someone, explain why not but try to organise something so that they do get some time with someone who can help. I know this won't solve the problems of staff shortages but we can all do our best.

And finally I just want to say a huge thank you to all of you that contributed answers to my questions about your experiences. I think I have learnt far more than I have put into this post, and I value each and every reply.


  1. what a super post.
    I really think that i managed not to fail - i remember my mw being really worried I would feel that and luckily I didn't. I was rather upset by people referring to a normal birth or natural birth - as if some how the csec was not unnatural. ok so it is - but some of that negativity comes from the language used.
    Also "failure to progress". that is where the sense of failure can come from. As someone recently pointed out I got to 9 cm - that's hardly a failure, just that for whatever reason, madam got stuck and it went no further. 36 hours labouring is not a failure... sadly though the language makes it seem that way.

    Again, Great post - plenty of food for thought!

  2. Absolutely agree PC - the language used is truly awful - failure to progress is easily the worst. Not to forget of course that birth is just one small part of the journey! Plenty of time to be accused of failure by our teenage children ;)