I did it!

Last week I was given the classification for my degree and I am very proud to tell you that I achieved a 2:1. We're now into the final pieces of paperwork and sometime next month (hopefully) I'll get my pin and be a fully qualified midwife. This month I shall attend an interview for a job and I know I've got my fingers and toes crossed that I'll get it.

It's an odd feeling right now. I'm exhilarated and slightly scared. I am scared of no longer having that mentor looking over me and ensuring that I'm doing things correctly. Yet at the same time I am looking forward to working independently, taking all that I have learnt from my various mentors over the past three years and developing my own practice.

I am proud to be able to say that I've made it. I have managed the demands of academic life, placement and family life. Once a long time ago, I began a journey to be a teacher and over half way through the course, I failed a major assignment and dropped out. At that point I thought I had given up the chance of ever getting a degree. I had no idea what I'd do with my life and didn't really think I'd ever make anything of myself. However I feel that I have also never really given up. I have always forged forward with the belief that there is something better out there for me; that I could do more.

I am not the greatest student, I wouldn't consider myself particularly academic. When I was doing my teaching course, I averaged very low marks, scraping through each assignment. My assignments as a student midwife, have been varied....some I've got it right and others I've not done so well at. I have taken something from each experience. I have literally taken it one day at a time, one challenge at a time...never daring to think beyond being a student and simply doing my best. I also could not have done it without the amazing support of my husband who always believed in me and my family's never ending support.

At the moment I am making the most of a little time off.....spending time with my children, seeing friends that I've woefully neglected over the past three years, spending time with family, catching up on my knitting and spending time preparing for Twirling Nationals with my daughters' twirling group (if you are interested you can follow them here http://distinctiontwirlersofmedway.blogspot.co.uk/2013/04/happy-easter.html ).

It's been a long journey and in so many ways, this is just the first step on the next part of the trip. I shall aim to continue to tell you all what it is like to be a newly qualified midwife. I am looking forward to taking that step but for now I shall enjoy spending time being me.

TV programs

At the moment there are numerous tv programs, both reality and fictional, that are showing midwifery or birth stories. Many of them irritate me for their inability to get things right.

For example last week in Casualty, which I have watched since I was a teenager, one of the characters was supporting her husband in hospital when she felt a pain in her stomach and worried that there was something wrong with her baby. The nurse laid her hand on the woman's stomach and reassured her "there is nothing wrong with the baby, you are in labour". I mean seriously....one contraction....yes that's how we diagnose labour these days. I can accept that there are some inaccuracies that don't matter to the public but surely most people know that labour is not diagnosed after one contraction. Then, because it's Casualty, they kept her in A and E rather than send her to maternity and they didn't even call for a midwife. It was ridiculous from the word go and it didn't get any better. When the fetal heart was at 90bpm, they merely called for the A and E consultant to deliver her and then called for a Special Care Anaesthetist when the baby needed resus. Pfft.. A small bit of research and this could have been handled so much better.

So then let me move onto Neighbours....now don't judge my choice of programs....I know it's rubbish but that's partly why I watch it! Like Casualty I have watched it for a long time and I'm not ready to stop yet. It's what I call my "no need to think about it" tv. Anyway they have had an ongoing storyline about two women who are pregnant, Sonia and Vanessa. Sonia has been planning a home birth, with the support of a doula. When her labour begins, her partner Toadie, panics constantly and tries to convince her to go to hospital constantly. When her waters break, she requires an urgent transfer to hospital and whilst it hasn't been aired yet, we know from the advert that following delivery Sonia is going to have some kind of collapse. When Vanessa goes into labour, she is declined the epidural at 8cms because it's too late to have one and then we see her being condescendingly praised whilst being encouraged to push her baby out a short while later. So now we know where the producers of Neighbours stand on the idea of home birth?

Why can these producers/directors or whoever is responsible, not just do some research into what is accurate and believable? It surely can't be that difficult. Anyone who has worked on a delivery suite knows how dramatic it can get. It already is a life and death situation and we don't need to make up details. There are also the beautiful labour and births that would make for wonderful viewing - we don't always need the drama! If all we ever see is things going wrong, then how can women believe it might just go right? Not every woman needs a hospital and doctors. Many many women could deliver their babies at home safely with the care of their midwife. Many women give birth in different positions to just lying on a bed. Many women never see a doctor throughout their pregnancy and labour. Most babies are born and require no resus at all.
Of course some women will need an obstetrician to lead their care and some women will require a hospital but it's not all women and this should be recognised in dramas and soaps. And it should not be seen to be unusual or weird but just one of the possible choices that women make.

I'd be happy to voice my opinion to any producer considering a birth story in their programme! Make it realistic.....that's all I ask!

Baby Loss Awareness Week

Today is the beginning of Baby Loss Awareness Week and tonight many women all over the world will be lighting candles to join in the Wave of Light, myself included. Will you join in?

Some time ago my friend Marie offered to write a guest post for me about baby loss and I didn't hesitate to accept. As often happens, life got busy and in the way, so it took some time to organise. However, both of us agreed that this week was the perfect timing and I think you'll agree that Marie offers some valuable advice to both students and qualified midwives alike. Thank you Marie x

How has this past week been for you? Has it been a normal week? Perhaps you were working long shifts in your local hospital, or you were on placement in the community. Maybe you were studying, or if you’re lucky you’ve been having a well-earned break.

I don’t know what all of you were doing, but I do know that about 120 of you last week were supporting someone who had lost a child to stillbirth or neonatal loss. And I know that 120 of you will be faced with doing this next week.

And then the same the week after.

And then the one after that.

Because as you may or may not already know, on average 17 babies older than 24 weeks’ gestation die every day in the UK, before or shortly after birth. As a midwife you absolutely will be dealing with these situations one day, repeatedly in most cases.

This week wasn’t a particularly out of the ordinary week, although you may well have seen more publicity about baby loss awareness recently. The campaign, for which I’m not a spokesperson may I say, brings together four UK charities that if you’re not aware of you could do worse than to have a read about: The Miscarriage Association, The Ectopic Pregnancy Trust, Antenatal Results and Choices, and Sands, the Stillbirth and neonatal death association.

Each of them publish guidelines and leaflets for health professionals as well as for those who are affected directly and indirectly by pregnancy and neonatal loss. Each of them offer support both for those affected and for you as healthcare professionals. I’ll even make it easy for you and link to some here, here and here.

Why do I care? Why should you care? And who am I anyway?

I’m Marie. I’m a 30-something mum from Essex, who wears either a personnel or photographer job hat depending on what day you find me – I’m certainly not in healthcare. I like cats and chocolate, but I try not to mix the two. I drive a little too fast sometimes, I bite my nails when I’m tired or bored, and I wish that Gok Wan made clothes for the shorter fatter people in society. My son died two years ago, before birth. I’m one of the women you might have met, or will meet one day.

So, when it’s ‘your’ week, what kind of midwife will you be for any of those 120 women, just like me?

Will you be the midwife who told me to ‘know my place’ in my first lost pregnancy, when I sat on the bed before she’d asked me to? Will you be the midwife who, in an open reception full of other pregnant women, asked me what SANDs did and what had happened, and didn’t know what the SANDs sticker on my notes meant? Will you be the midwife who assured me I would not be placed next to a labouring woman after my son died, but then couldn’t understand why I was traumatised when they did exactly that? Will you be the midwife who drew the curtains around my bed in HDU rather than have to watch me cry? Will you be the midwife who, after the scan to confirm my son had died, told me all about her children and large family? Will you be the midwife who dismissed my tears and told me off for raising my blood pressure without offering support to me?

And if you’re not a midwife, but you’re another healthcare professional, will you be the one who ignored my requests for pain medication and told me to keep the noise down so I didn’t upset others when I was labouring with my late miscarriage? Will you be the one who chatted about Christmas at the end of my bed instead of getting me the bedpan I had asked for? Will you be the one who refused to admit me, bleeding heavily and screaming, to ER until my husband had filled out forms?

Will you be the amazing midwife sonographer who supported me through multiple pregnancy losses and successful pregnancies, made time to talk in the waiting room, minimised the delay and wait for scans, and provided tissues when it was all too much? Will you be the comforting midwife who always made time to listen and explain when I didn’t understand the printout from the DAU during my exhausting last pregnancy and just COULDN’T leave the hospital before I knew whether my son was okay? Will you be the caring midwife who understood why I was distraught that I had been assigned to be seen by a junior instead of my consultant at a key stage in my subsequent pregnancy, and arranged a better appointment for me? Will you be the home-visit midwife who held me while I cried when she visited me to check my blood pressure after my son died, and made special trips to come and see me, taking her time to sign me off until she was sure that I could get through a day? Will you be the labour midwife who stayed by my side during my entire 7 hour labour with the boy who would never cry, open his eyes, or smile, helped my husband dress him, and took his precious pictures and handprints? Will you be one of the midwives who visited my other son in NICU when he arrived early and I was in recovery, taking personal delight in sharing a happy end to my story?

This week, as a midwife or a healthcare professional looking after pregnant women you cannot choose not to deal with these situations, in the same way that I and my fellow women have no choice but to endure them. You can, however, choose how to deal with them, and how you are remembered afterwards. What will you choose?

For some stats on Baby Loss watch this.

For more information click here.

Another placement finished

Two more assignments submitted and suddenly I'm halfway through the course. Everyone told me that the time would fly past and they were right, it really has flown. I'm looking back at all I've done and learnt and feeling quite proud of myself and yet I can still look at all there is to learn and feel overwhelmed by it all. Over the past 18 months I have seen a variety of women with very different needs,and a variety of different midwives with different ways of working. I've seen normal births and I've seen births that needed high levels of expertise in order for mother and baby to survive - all of which I have learnt from. Sometimes it can feel like what we do at Uni, is a distant cry from what we do on placement. After all our first 18 months of training has been focused on normality but of course what we see on placement can be very different. One thing I have learnt is that remaining focused on what is normal, helps to identify when something isn't within the realms of normality.

A simple example of this is when we first palpate the uterus to see what position the baby is in, in a woman who is 40 weeks pregnant. Focusing on normality, we would expect the baby to be in a head down position so if the baby is not in that position, we can identify this and then act appropriately. At the beginning of my training I didn't really have a clue what position the baby was in but with practice I soon began to be able to tell. I even managed to identify a baby in the breech position. As I've continued in my training, I've become more and more confident and even at an earlier stage of pregnancy, can often identify the position. That said, I am not afraid to say when I'm not sure and to ask the midwife I am working with to have a feel and see what she thinks. It's essential to be comfortable enough to say "I don't know". There is no shame in not knowing something, there is shame in pretending that you do.

It's not unknown for a doctor to request a second opinion and I've witnessed qualified midwives ask for another midwife's opinion. Yet I know it can be difficult to say 'I don't know'. I'd say it's probably more difficult at the beginning of your training because you don't know yet whether or not you should know the answer and whether you'll look foolish if you don't know. I still maintain that you look far more foolish if you pretend to know the answer....you will get caught out. These days when I come across a term I don't know - usually when booking someone, they mention a medical condition I've never heard of - I'll ask the midwife I'm working with, or I'll look it up. We can't know everything after all.

So if you are about to start your first placement then there is your first bit of advice - don't be afraid to say you don't know something. BUT don't wait for someone else to find out for you - look it up - google is your friend!

5 years - a sensitive post!

Today it's been 5 years since my brother lost his fight against the brain tumour in his head. The night before I had been so happy, his son had been born on the Saturday and whilst he hadn't been well enough to be there, we were hoping that his wife and son would be home on the Monday and he'd meet his son. However in the early hours of Monday 8th May 2006, he slipped away peacefully in his sleep. Whilst he never did get to hold his son, he did at least know that he had been born and that had made him happy. Losing my brother changed me - in ways I can't really explain, all I know is, I am different to the person I was before he died.

This week a friend of mine had her life changed forever in one of the cruelest possible ways. Her son William, who was soon to be 3, didn't wake up. He hadn't been ill, though he'd been under investigations as it was thought he had epilepsy. They'd been on holiday and the day before they'd spent the day at the beach and he had thoroughly enjoyed playing in the sand, and chasing a beach ball. It is wonderful that his last day was so happy and carefree with his parents and older sister, and I am sure that those memories will bring comfort as well as pain in the days, weeks and years ahead.

I know William's mum, through an online community. Some people might fight it strange that I keep sobbing for William...after all I never met him. I have met his Mum but never his Dad or older sister. However the nature of the online community means it felt like I knew him, like I knew him almost as well as I knew my "real life" friends. I know I'm not alone in feeling like this - the whole community has been shocked. Many of us have children of similar ages, we've debated the SIDS guidelines, the appropriate weaning foods, breastfeeding, co-sleeping etc. It's seems trite to say it, but things like this don't happen to people you know but unfortunately that's just not true. Many members of the online community are buying and planting Sweet William, in his memory. A memory that should always be kept alive.

This week I have had times where I got cross with one of the girls for leaning on me, for not leaving me alone, for not going to sleep when they should, for not getting dressed quickly enough. I have worried about money and stressed over housework. When I read the news from my friend on Friday, all I wanted to do was gather the girls in my arms. I know I am not alone, in checking more frequently on the girls when they are sleeping. Life was thrown into perspective in a very harsh way.

I can't help William's Mum and family, I can't ease their pain. I can't begin to understand how they feel at the moment, though some feelings might be familiar to me, grief is different for everyone. Today I shall be spending time with my parents and my sister, and with our children. We will be lighting a candle for David, my brother and I shall light a candle for William. Take a moment today, to appreciate what you have - give someone a hug, tell someone you love them, smile.

RIP William, you will be missed x

And so begins 2nd Year

We are no longer shiny and new. We've all had different experiences on placement, good and not so good. We've all already started to think about the kind of midwife we want to be - learning from those we've been working with. We've even already become a little cynical about the changes we thought we could make because we've seen how restrictive working for the NHS can be.

I've been back in Uni for two days and already I feel revitalised and hopeful about my future. During one of courses we will be looking at hypnobirthing and complementary therapies and I am so excited...this is exactly the kind of midwife I want to be. I want to embrace normality and encourage women to believe in their bodies to give them the best possible chance of a normal birth. Did you know that it is a well known phenomenon that women's labours halt or slow down when they enter a hospital? Did you know that it was only once the doctors got involved that babies began to be born in hospitals instead of at home?

Don't get me wrong, I 100% believe that hospitals have their place and women and babies lives have been saved as a result. However I do believe that for the majority of women, home would be a perfectly safe place to give birth. I may well be biased having had personal experience of a home birth and loved it but it is something I am passionate about. Sadly I also believe that we are a long way off turning things around again. Women have different expectations now - they expect pain relief, they expect doctors or midwives to tell them what will happen and when, and so on. It's not that women are wrong but perhaps we are wrong in how we guide women's expectations if that makes sense?

It's not often that I hear people say that they loved their antenatal classes...at least not once they've had the baby. The most common statement I hear is that the classes didn't prepare them in any way? So is this where we are going wrong? Is this where we can make a huge difference to how birth and labour is viewed? I do believe that no-one can be fully prepared for just how much parenthood changes your life but I also believe we could prepare women better for birth, and increase the chances of a normal delivery. I've been on the receiving end of wonderful, inspirational antenatal discussion that led me to my home birth. However I was also fully prepared for if things hadn't gone to plan, and I still had plans in place to maintain control of MY birth. Shouldn't all women be given that opportunity?

I would also like to make the disclaimer that I am not saying that anyone who hasn't had a normal delivery, had unrealistic expectations. There is many factors to consider and I am certainly not in a position to judge whether or not someone was given the opportunity to have a normal delivery. Do you think you were well prepared for the birth of your baby?

11 births and farewell MLU.

I've now finished my time on the MLU and next week I am off to the antenatal clinic where the experience will be extremely different. It's hard to believe that before this placement, I hadn't "caught" my first baby and now I've caught eleven. Eleven very different woman, who coped in very different ways with their labours. Eleven different birthing partners who supported their wives/girlfriends/daughters in a variety of ways. So many of the birth partners say how useless they feel whilst the woman is labouring. They simply don't have any idea of how valuable just being there can be.  And lets not forget the eleven very different babies. Six boys and five girls.

I'm not sure I can put into words just how much I feel I have learnt in such a short space of time. I've worked with different people and they all have their own ways of how to deliver and no doubt over time, I will choose my own preferred way. I like to think at the moment that I will work with whatever is appropriate at that time but ideally, maybe even idealistically, I'd like to be fairly hands off in my approach....allowing women to be in charge of their own bodies and deliveries. I think back to the births of my children and how I feel that my eldest was delivered by the midwife, and how my second was delivered by me....I know which experience I'd rather women have.

However one thing I have learnt is that no matter what I think, the woman has the right to make her own decisions. Whilst for me, being continuously monitored or unable to feel the contractions would be awful, for another woman, this is very important to them and part of being a midwife is taking a holistic approach and recognising what is important and why; ensuring that women have all the information they need to make an informed decision so that after the baby is born, they have felt a part of the decision making process and supported in their choices. What I would do is actually irrelevant in so many ways. So as well as all the clinical skills I am learning, I am also learning how to listen to women and support their choices.

Today I am feeling on top of the world, so pleased with all I have learnt and achieved. I'd love to bottle it - I could make a fortune! Or just have a little sip at those times when I am wondering if it is all still possible. For now I shall bathe in this happy feeling, enjoy a few days off and look forward to another new experience on Monday!

No more assignments!

For this academic year anyway. On Monday I submitted my final assignment for this year, providing I don't fail one anyway and have to re-do it. We only had three assignments to write this year and each one was harder than the last. I'd thought on reading the brief that the Values assignment would be quite enjoyable. However it was easily the assignment that challenged me the most. I work well with facts and being able to reference from research; but talking about my feelings about something was far harder. For those that know me well, this may come as a bit of a surprise. I wear my heart on my sleeve and don't generally have any problems talking about my feelings. However it's quite different when you have to reference your feelings somehow....once I was talking about theory I was far more comfortable. Anyway I am pleased it is finally submitted and shall now be obsessively checking for my results.


I've now got a few days off before returning to the MLU. My fingers are twitching to catch my first delivery. I've been watching One Born Every Minute and thoroughly enjoying it but it only serves to remind me what I want to be doing. I loved this weeks episode - no Caesarean's, just normal birth and not just that but a water birth! I felt quite emotional watching that one....and also quite lucky. In fact I feel lucky most days - midwifery is so competitive to get into, and getting to see new life enter the world - well that's special. I know it's not every one's cup of tea but I find it so amazing and special, and a privilege to be a witness to. It's not just the births though - it's the whole experience of caring for women at such an amazing time in their lives.

My most recent part of placement was spent on a postnatal ward. Unlike the MLU, on this ward can be all the high risk women, post-section women, post post-partum haemorrhage women, women with high blood pressures, diabetics, and the list goes on. Also on this ward are antenatal women, who are in for monitoring, are in early labour or have come in for induction of labour. It's a fast paced ward and a very high need ward. Some shifts I'd feel I was chasing my tail the whole time but I learnt so much.

One day I spent a long time helping a new Mum with breastfeeding amongst other things. She was quite an anxious new Mum so she had a lot of questions. She'd waited a long time for her baby and she was determined to get it right. As we weren't too busy that shift, I was able to spend quite a long time with her, providing one-to-one support and giving her confidence in herself. When she left to go home, she gave me a big hug and said thank you for my help. There aren't many jobs where you'd get that response from a client! I love my job!

Happy New Year!

A new year is often synonymous with new beginnings and hope, happiness and celebration. I am looking forward to catching my first baby this year, hopefully soon and then becoming a second year student midwife in May. I have hopes of weight loss and being healthier. I have many celebrations to look forward to - two ruby weddings, two 65th birthdays, an 18th and a 21st birthday, two 40th birthdays and a wedding to go to.

However for many the new year can be tinged with sadness - for me it's the beginning of another year without my brother. Today I visited my brothers tree:

I love the cemetery where my brother's tree is. There are always people visiting, there are always fresh flowers and it's a lovely place to spend a contemplative moment. Whilst there I often wander to look at gravestones, or memorials, particular when there is a new one crop up. Today I wandered to spend a moment in the baby and children area - such sorrow and such pain and yet such beauty. The babies gone but not forgotten, still bought gifts though they are not here to enjoy them. The sadness of losing a child seems somehow greater than losing an adult and I'm not about to debate how true that is. Truth is loss of any kind is painful and times of celebration can highlight their absence.

Today I shall light a candle for my brother, but I shall also think of others who have lost loved ones and remember them too. Whilst we think of them, and talk about them, they are never forgotten. Don't ever be afraid to talk to someone about their lost loved one....it helps to know someone else remembers and cares.

Happy new year to you all. I hope 2011 brings you all happiness and laughter, good health and maybe just a smidge of wealth too.

What kind of midwife do I want to be?

All of the posts about breastfeeding, discussions with friends about breastfeeding and then listening to qualified midwives talk about breastfeeding got me to thinking about what kind of midwife I want to be. I don't have these grand illusions that I can get every woman breastfeeding their babies. I don't think I can change the world after all. So what can I do? What kind of difference can I make?

Well this is my dream....I want to support those women that do want to breastfeed. I want to help them have skin to skin with their babies, to breastfeed as soon as possible after the birth of their babies. I want to make sure that women know where and how to access support should they want and/or need it. I want to provide women with accurate information, without ramming it down their throats. Then following this, I hope that gradually more and more woman have a positive breastfeeding experience, and that this drip feeds to more and more women, that breastfeeding can be easy and enjoyable. That breastfeeding becomes commonplace to be seen everywhere and that women can learn by example, just like women used to do.

I also want to ensure women know about their choices for birth - whether that is where to give birth, what position to give birth in or whether it is how to still feel in control should they need a Caesarean delivery. I want to be able to support women in their choices without cynicism. Of course, I also want to be able to know what to do in the event of an emergency, or when things don't go to plan. And when things don't go to plan, I still want to be able to support women in their choices. I want to be able to help women know what their choices are. I want them to still be able to have a positive birth experience knowing everything possible was done.

I have no doubt that some people think my dreams are daft, that I am aiming too high. But if I can support one woman, help one woman to feel that I made a difference, then it's a start. I am writing this in the hope that I don't forget my dreams; that I remember what is in important to me and that I try and keep to it as much as I can. I'll aim for making a tiny difference and hope that I succeed.

Breast is Best?

The WHO (World Health Organisation) guidelines state:

"Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproduction process with important implications for the health of mothers. As a global health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production."

So there you have it - the official guidelines from those in the know....so why is there so much debate over breastfeeding? Why are people surprised to see babies older than 6 months breastfeeding? Obviously I am only talking about in the UK here, as I can't speak for anywhere else. I think the answers are quite simple really:

1) Breastfeeding can be hard work to get established. It can be painful and sore.

2) Breastfeeding is often hidden away as something private, particularly with older children. Therefore unless you know someone who breastfeeds, your experience with it may be very limited or even non-existent. 

3) It's an emotional topic and when breastfeeding doesn't work out for someone, it can affect how they feel about it. 

Apparently only 2% of women cannot physically breastfeed either due to medical conditions or for an unknown reason. A common misconception, particularly in the 1960's and 1970's, was an inability to feed due to a lack of milk. It is unlikely that this would truly have been the case for the majority of women who switched to formula milk. This was a time when women were advised to put their babies into 4 hourly routines and not feed them in the night time which is has since been evidenced as being detrimental to milk supply. However it is something that is still said today, and many mothers are still worrying about routines and length of time between feeds, and consequently questioning their ability to produce enough milk. There is also little known about growth spurts, so when the baby is suddenly feeding all day and all night to increase milk supply,  again mother's can question their milk production - sometimes leading to early weaning onto solids; but that's another debate! 

So anyway that's the guidelines and official figures - still doesn't tell you my opinion does it? 98% of women can breastfeed....does that mean that 98% should? No I don't believe it does. Nor do I believe that repeatedly telling people the health benefits is the way to increase the number of breastfeeding mothers. I believe that some antenatal class teachers, some of whom are midwives, are almost frightened to talk about the difficulties that women may have with breastfeeding, worried that it will stop women from even trying. Some midwives don't discuss breastfeeding at appointments for a variety of reasons, such as not having enough time, thinking it's too early to consider, that it will be covered by antenatal classes, that anything that is said won't be remembered anyway etc. 

Some women don't want to breastfeed. They don't want to try and it doesn't matter what anyone says to them, they simply don't want to do it. Is that wrong? Well it might be an alien feeling to my own, but it doesn't make it wrong. We are lucky to live in a country of choice, where formula can be made up safely with clean water and for some women the choice is clear, and they choose formula. 

A lack of support is probably the most common reason for women to stop breastfeeding - whether it is a lack of support from health professionals or family and friends. This can be combined with pain, or a lack of knowledge about how breastfed babies feed. I have alluded to routines and growth spurts already but this aggravated by comments such as "are you feeding that baby again?" or "why don't you give that baby a bottle?". There is no benefit to comments such as this and for a mother who has pain and is unsure what she is doing, it can't help. 

Some women try to breastfeed but stop because of pain and soreness. There can be a number of reasons that there is pain during breastfeeding, most of which can be corrected. If the baby is positioned incorrectly, then the nipple can become very sore, cracked, even bleeding. If the mother is given support and advice before too much damage is caused, then the mother can go on to breastfeed as long as she likes. Poor positioning can sometimes also lead to mastitis as the milk ducts aren't emptied properly but again with the correct support and advice this is easily remedied. Nipple thrush can be another cause of pain to the mother, but also to the baby. Once identified, both the mother and baby must be treated simultaneously or it will continue to be passed from one to the other. Thrush can be a nuisance to get rid of, and it can be a nuisance to get the correct treatment for, but with the correct support and advice, it is easily dealt with. Engorgement is also a common cause of pain for the mother, especially when the milk first comes in. The easiest way to deal with it is feeding the baby although it can make it harder to get the baby latched on, in which case, it can be easier to express a little milk off just to make the breast softer. There are other causes of pain of course, but these tend to be the most common so I have focused on these for now.

However before anyone thinks this is a pro-formula post, it isn't. For me, it is like choosing to buy powdered dried milk in the supermarket instead of the bottles of milk in the chiller. It is a perfectly good substitute but it's not what I would choose - give me fresh every time! Wouldn't you say that's what most people do? Isn't that how breastfeeding should be? The norm? In cultures where breastfeeding is the norm, problems with positioning are practically non-existent. Women are used to seeing breastfeeding, and learn from childhood how to position their babies. They automatically support each other, and after giving birth, the family rallies around so that the mother can get used to her baby and get feeding established, without worrying about visitors and the housework. 

I am proud that I have breastfed my children. Whilst the health benefits didn't matter to me before, they do now. I am glad that I have given them the best start in life but at the same time I am incredibly grateful that I had the right support in order for that to happen. I hope I don't come across as smug about it, but actually help to further the view that breastfeeding can be easy, pain free and enjoyable and that it might just be worth a go?

Coping with negativity

I am now 6 months into my first year, have completed my first placement, my first assignment and my first exam and already in this time I have experienced a large degree of negativity.

There can be negativity before you even begin the course, from professionals, from family and friends, from complete strangers....those who wonder why you want to be a midwife as they couldn't imagine anything worse as well as those who know how difficult it is to get a place and wonder why you want to put yourself through it. In all honesty, I partially feel this is like the first test of how much you really want it. If someone can put you off so easily, before you've even tried, then maybe you don't want it enough.  That said, I have been lucky in that the response from my friends and family has been incredibly supportive and I know that I will need them when things are tough, when perhaps I do doubt if I am doing the right thing.

I have talked before about reading on forums about poor placement experiences some students have had at the beginning of my "What Makes a Good Mentor?" post, and I don't want to repeat myself, so you can just go back and re-read it. However in a nutshell, I guess I am talking about the negative attitudes of others towards students. I know that I have said to my fellow students that as first years, we truly are the lowest of the low, and I have heard tales of being treated as a completely different person once qualified. Is it right? No of course it isn't but is it going to stop happening? Not any time soon, I am sorry to say. The only thing I would like to be sure of, is that I won't treat students that way or anyone in fact.

The other kind of negativity you can come across, is the negativity of qualified midwives towards the job, and sadly the women. As a first year, I am at a stage where I feel passionate about childbirth, choice, breastfeeding and supporting women in their choices. I don't want to change how midwifery is practised (I'm not wanting to change the design of the wheel after all), I have no urge to change the world, but I do want to support women to the best of my ability. I don't want to lose that passion that I arrived with, through working with midwives that are jaded about childbirth through the experiences they have had. I certainly don't want to criticise anyone I have worked with; I am hardly in any position to do so with the limited experience and knowledge that I have. So instead I thought I'd write a little bit about how I hope to deal with it and maintain positivity.

By keeping a record of my passion in this blog, I hope that I can always read back on it and remember why I wanted to become a midwife in the first place. That after a difficult shift, or when I am in the midst of assignments and feeling stressed, I can come here and read this and just remind myself why. That I can read about the people that inspired me, the stories that saddened me, the women who I wished had had better experiences to remind me how I don't want to be.

I also have an excellent support network of friends and family who I know will always lend me an ear, and encourage me when I most need it. They are also there to help me take a break, and give me some time out from the pressure. My husband is wonderful and will take the children out so I can have some space, and not only to study, sometimes so I can just have a bath and watch the TV in peace. I think it's valuable to know when to stop and take some time for yourself as this helps you to keep going.

I am also a member of forums where I can share opinions and ideas, gain support and have debates over all sorts of topics. I can also speak with my fellow students, in particular those that are based with the same trust as me, as they know the same people as me. It is going to be interesting to see how we all change and grow along our journey to be midwives. I think we will all learn just as much from each other, as we do from our own experiences.

I've recommended to friends who are pregnant, to listen to all the advice, take what you want and leave the rest behind. I hope I can apply this to my learning too, whilst of course maintaining my knowledge for safe practice.