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!

Thinking towards the future

Yesterday the group ahead of ours graduated. Wow! Well done to all of them. However it does bring it home, that soon it will be us. Our lecturers are beginning to talk about job applications and portfolios and other paperwork that will need to be completed before we can qualify. In just a few weeks we will begin our final placement and we'll be aiming to get as much experience as we can whilst we are still students. I know I definitely feel like I still have so much to learn, and that there is no way I have enough time to learn it all. However I do feel that it is a bit like driving and passing your test. At first you know enough to pass...you've got the basics but you need experience to become more confident. You certainly can't know what you've never faced. I don't worry about it because I think it's far more dangerous to think you know it all. We are life long learners and it's important to remember that.

At times I still feel completely overwhelmed. If I think about my dissertation and assignment still to be written, my portfolio to complete, my genetics workbook to complete and everything else, I feel slightly ill. Therefore I try really hard to concentrate on one thing at a time. And that's just the academic side of things. This placement we also have to get all of our required deliveries and ensure we've got all our hours. I only need three more deliveries thankfully but I know that there are some of my cohort that need far more and they'll be pushing hard to get them now, so that they can qualify together with the rest of us.


In between studying and researching for my dissertation, I am spending quite a lot of time with my daughters Twirling group http://distinctiontwirlersofmedway.blogspot.co.uk/. I do think it is vital to have some time out from being a student midwife and for me, spending time with my family is essential. My eldest daughter has been twirling for just over a year now and my youngest joined her just a few months ago. Over the time they have been going, I have made some fantastic new friends and they too offer me support as a student. My eldest daughter used to be quite shy but her confidence has increased tenfold, through this hobby. This weekend, they both attended a competition and were both were fortunate enough to come home with trophies. A year ago I would never have thought it could be possible.


Recently I also helped at an open evening at my University. I really enjoyed seeing the potential students and their enthusiasm for midwifery. It reminded me of when I first started my journey to become a midwife and how excited I was. I am still excited about becoming a midwife and I look forward to my career and supporting women at such an important time of their lives. So when the amount of work to be done is getting me down, and overwhelmed, I just remind myself of why I set out on this journey and I battle on another day!

Passion and Inspiration

Sometimes I find myself bogged down in the workload. For example, at the moment we are working on two assignments, about to return to placement and in January we have a presentation and a biology exam. In the midst of this, I am also attending meetings in my capacity as set rep and trying to plan for Christmas, spend time with my family and friends and there just isn't enough hours in the week. Consequently I'm a little rundown at the moment, with cold after cold and a constant feeling of tiredness. So it's easy to wonder how I maintain my passion for midwifery, and to keep that light at the end of the tunnel to aim for.

I try to maintain my passion for midwifery through reading - I'm always interested in the use of techniques I've never seen in practice and that we're unlikely to be taught. For example, the use of water blisters to help with the pain in a back to back labour. If you've not heard of them before then have a read, it's really interesting. Something else I was reading about recently was a technique for dealing with shoulder dystocia where the mother is aided into a running start position which is explained here.

I also recently attended a water birth study day which re-ignited my passion for water birth and home birth. Prior to beginning the course, it was of course my own home water birth that inspired me to become a midwife and yet I am still to attend one myself. The study day reminded me of how to trust in women to be able to birth their babies without any intervention. It also highlighted to me the amount of fear there is surrounding home birth - from the health professionals as well as the women. Fortunately this isn't true of everyone but clearly a significant enough number for the percentage of women having a home birth to be extremely low. According to Birth Choice UK, just 2.39% of births in the UK were home births and in the area where I work just 2.2%, a figure which hasn't changed much in the past 10 years.

This week I was fortunate to be able to attend the RCM student midwives conference in Brighton. As well as the superb amount of freebies from all the stands that were there, I also had the opportunity to listen to some inspirational speakers. I was able to hear from other students, newly qualified midwives and midwives who had been working in the profession for a long time. If you ever get the chance to attend then I thoroughly recommend it. It's hard for me to sum up exactly how much you can gain from the experience. I'd also recommend any other conferences you can attend, such as the ARM conference or any other event where you might have the opportunity to hear such inspirational speakers.

So when I'm feeling the pressure of my workload and all I'm really doing is worrying about how I am going to get it all done, to the best of my ability, sometimes I just take some time out to remind myself why I am doing it and I then find I can focus better on my work. Alternatively I also have times when I just have to push on, push past the point where I feel everything I am writing is rubbish, to the point where it begins to make sense. Trust me, it does happen sometimes.

If you haven't done so already, can you please sign the petition for more midwives!
http://www.rcm.org.uk/college/campaigns-events/protect-maternity-services/

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!

Fear

Becoming a parent can, for some, be the most frightening experience in the world. You can ask about others experiences, you can read all the books, you can look on the internet but nothing can really tell you what it's going to be like. It is quite normal for first time mums to focus on the labour that is ahead of them and read all you can on the subject or alternatively, completely stick their heads in the sand and not think about it at all. I was someone who had to read everything I could. For me, as a future midwife, as someone who has been through labour twice, as a mum who wonders what parenthood will bring that day, I wonder if I can help alleviate some fear? I certainly hope that I can, for women that I work with and with friends who are to become parents in the future.

Labour is certainly something that holds a lot of fear and it's understandable that it does because anything that involves pain, is something to worry about. Instinctively, as humans, if there is pain then there is something wrong. However labour is unique in that, it is the only time that pain is actually a good thing. If you are someone that has had a tough pregnancy, or you go overdue, or you've just had enough of waiting, you may even find yourself wishing for the pains to start. The one time in your life, you will wish for pain?

Television doesn't help of course...it gives the impression that when you go into labour your waters will break and you are instantly in agony. I'd hope that most people realise that labour generally takes longer than how it is usually portrayed on the tele. For most women, labour begins with mild, irregular pains. Many women liken them to period pains. You can breathe through them, you can walk through them, you can easily talk through them...not like they'd have you believe in Albert Square. They can be 10-15 minutes apart, they can stop for a few hours and then start up again. This is the main reason women are recommended to wait before rushing up to the hospital. Yes they hurt, some are stronger than others but as it's not a constant pain it's something women can cope easily with. The fear that can accompany those pains however, is what some women find difficult to handle. The not knowing how long it will last for, can be difficult to handle. And sometimes whilst the pain isn't that strong yet, it can still prevent women from sleeping or getting comfortable, and this can have an impact on how well women cope.

I believe that fear surrounding labour and birth should be handled at the antenatal stage, or perhaps pre-conception would ideal. I wholeheartedly believe, that in the delivery suite is not the place though. It's much more difficult to maintain normality when someone is terrified. It's not impossible and I have witnessed some amazing midwives who can calm the most frightened of women, and ground them, manage their fear, soothe them and make them feel safe. I hope to be this kind of midwife. I believe that the overwhelming fear that some women experience does sometimes lead them to choosing an epidural for pain relief. They don't know what to expect and how long it might take. Providing women with accurate information, and helping them to make an informed decision is vital. Being able to alleviate their fear is also vital. I have witnessed frightened women "choosing" an epidural and as someone pointed out to me, how can it be an informed choice when it is a fear based decision. Women should not reach this level of fear.

When I was pregnant with my second daughter, I attended an antenatal group, as previously mentioned in my Inspirational Midwives post last year, where I was given all the information I could possibly need to make an informed choice about where I wanted to give birth, my pain relief options and what to expect if things didn't go to plan. I always wished I'd attended the group when I was pregnant for the first time. What I find incredibly sad, is that group had to stop running due to a lack of funding. Those midwives inspired a number of women to have a home birth, who in turn inspired others to also have home births, and that cycle is still continuing, their inspiration still continues on. They gave women a voice, because they provided the information, they probably saved the NHS a lot of money because a women who knows what to expect, needs far less interventions, would decline unnecessary interventions. In an ideal world, the community midwife would be able to handle all fears about labour and birth during an antenatal appointment. Sadly there just isn't time - too many women and not enough midwives. Midwives constantly thinking about the next woman they have to see....it's not that they don't want to, it's more that it's just not possible.

Fear is the biggest barrier for a woman facing labour and birth. Time is one the biggest barriers facing the midwife. My biggest fear about becoming a midwife, is not having the time to be able to give women the care that they need, that they deserve and becoming frustrated with time constraints. I hope to remember the midwives who managed to give the time without neglecting others, somehow found a way to manage it. 

Into delivery suite I go...

So here I am, a second year student and I've just started placement on Delivery Suite. On Sunday night I had butterflies in my tummy, and I was really nervous about starting placement this time. In part I think it's because wearing my second year badge, means I am meant to know stuff. Of course I do know a lot more than I did this time last year but there is still that feeling that you are faking it and soon someone will discover you don't know anything. It's a bit like the feeling that you are playing at being a grown up when you have children...I am sure some of you know what I mean.

Anyway I had my first shift on Monday and I felt like my head was full of cotton wool at the beginning of the day. It's been quite a while since we were last on placement and I had to get myself back into mindset and remember how things were done....mainly the documentation. Also this is the first time I've worked on Delivery Suite, having worked in the Midwife Led Unit before so I'm learning how things are different. The main difference is that there are far more high risk women being cared for which means that the CTG machines are used for monitoring, in some cases continuously throughout labour. Then there are the women who are on drips for inducing labour, women with epidurals, women with pre-existing conditions that need to be monitored, women carrying twins (or more), women who have had bleeding during pregnancy, women with high blood pressure, and anything else you can think of really.

In comparison with the midwifery led unit, delivery suite is more fast paced, and busier. There is always something going on. The doctors are also far more involved with care and decision making. One of the things I have learnt this week, is how quickly things can change, and how quickly the staff can move when they need to. For low risk women, the constant monitoring is not needed, but once you begin to intervene and various drugs are used, there can be a reaction to that drug, and it can be very sudden. However with the monitoring that is used, the response to any reaction is swift.

I've watched One Born Every Minute and how the midwives are portrayed - sat in the office drinking tea and eating cake whilst women labour on their own. I have to say this is definitely not my experience. Where I am the midwives spend the majority of the time in with their women. They may grab a cup of tea at some point, but often they don't get the chance, and I don't like to think how many midwives miss getting a lunch break because it's just too busy. Would you not agree that it would be a safer and happier environment for all if there were enough staff to ensure they got a break? It's not that I think it's unsafe where I am fortunately but I can definitely see that there would be a huge benefit to all, if there were more staff.  You can't predict who will walk the door, with what "problems" so you always have to be prepared for anything. Delivery suite needs midwives who work as a team, supporting each other, alongside the doctors, anaesthetists, maternity support workers, cleaners etc... Everyone has a vital role in delivery suite and communication is essential.

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!

Passion and fear

This week I have witnessed two ventouse deliveries - this is where a suction cap is attached to the baby's head and as the woman pushes, the doctor pulls which helps the baby to be delivered. There are various reasons why a ventouse delivery might be deemed necessary - maternal exhaustion, prolonged 2nd stage (the pushing stage), fetal distress, amongst others.

Of the two ventouse births I witnessed, one was due to slow progress in the 2nd stage and the other was due to fetal distress. I can't really share too much information about the deliveries themselves due to confidentiality but in the event of the fetal distress, my heart was in my mouth and I felt very emotional when the baby was safely delivered. I'd helped to care for the couple all shift and learnt quite a lot about their journey so far, and therefore I found it mattered a lot to me, my part in their story. I was really pleased to be able to see them again the next day. 

I now have 5 deliveries to my name, three of which you already know about in my last post Not one but three. I've been lucky to work with a brilliant team and I feel like I have learnt loads in just the last week. Four out of my five deliveries were in the semi-recumbent position but the fifth (actually fourth but this could get confusing) was on all fours.....it was brilliant to get my head round exactly where I was putting my hands, and to have a different perspective - however I have got to say....it's far messier. My final delivery of the week was lovely and controlled and as a first baby, my mentor had loads of time to point things out to me as the baby progressed. 

This week I am onto day shift and I think I will experience very different shifts to the night ones - there will be far more postnatal checks that need to be done than there are in the night time but there are also generally more staff. It will be really interesting to see the difference though of course I am hoping for a couple more deliveries and moving towards becoming more autonomous. I shall be investing in a book where I can keep a record of all my own deliveries as I am sure I will want to look back on them all one day. 

One thing that has struck me this week is the value of good support. I have been told how lucky I am to be able to witness birth and I agree I am lucky. However I am also lucky to witness the amazing roller coaster of emotions during labour and the special bond between the woman and her birth partner.  I have seen the love, the fear, the hope and the excitement all in the eyes of the birth partner as well as the woman. With the couple whose baby was in fetal distress, I witnessed the pure joy on the face of the mother, that the time had arrived to meet her baby, which was contradicted by the absolute fear in her partner's face as he could see the slowing heart beat and the number of people suddenly in the room. Not for one moment did he let his wife know just how worried we all were, but he continued to support her, to encourage her and be by her side the whole time. And then once the baby was born, I continued to watch that amazing bond between them, the continued joy and amazement on her face, and the relief and joy on his. You tell me I am lucky - I wholeheartedly agree and  no matter how lucky you think I am, I know I am 20 times more lucky than that. 

Not one but three!

I made my way to the hospital last night feeling quite excited about the prospect of getting my first catch. I met with mentor and she asked where I was at with my training and I was quick to tell her that I'd made all my witnesses and was itching to get my first delivery. Funnily enough she also wanted to know about what else I'd done. 

We began the shift with a very quiet ward. We made sure the rooms were equipped, checked equipment, tidied up....found things to do. We soon had a couple come in from triage, whom we settled into a room and did the necessary checks that needed to be done, before encouraging the woman to mobilise. She was very comfortable so other than the regular checks on baby's heartbeat and how Mum was coping, we left them to it. When she was next checked, she'd not really progressed so my mentor broke her waters and her contractions soon became more intense so I began to spend longer with her to help her cope.  The next couple of  hours passed fairly quickly and my lady was having some early urges to push, so I spent a long time helping her to breathe through the pains instead. After a short while, it was apparent that she was really struggling not to push, so we encouraged her to use some pain relief, so she opted to use the entonox

At 5.00 my mentor returned from her break early, and told me to go to another room quickly. So I dashed off guessing that it meant a delivery was imminent. Sure enough, I entered the room and could already see the head beginning to appear. I quickly gloved up and put an apron on. Supported by the midwife, I caught my first ever delivery of a baby boy at 5.05.  I checked over the placenta with the midwife, cleaned myself up and then returned to my lady who following a dose a pethidine, was dozing between contractions. After a short while, she was still pushing with the contractions, so I popped out to see if my mentor had returned, as I knew she was due another examination shortly. At which point I was hurried into another delivery room, to quickly glove up and catch my second delivery. The lady was very controlled and very quickly delivered a baby girl at 5.25. Again I checked over the placenta with the midwife, and got cleaned up before returning to my lady. 

On my return to her, I felt that she was now really struggling to breathe through the pains and she just sounded like birth might be imminent. So I popped out to check on the whereabouts of my mentor, who'd got caught on the phone and reported what I'd observed. She returned to the room with me, ready to perform a vaginal examination to check how she was doing. At which point, we discovered there was no need to perform an examination, as we could see the head beginning to appear. Unlike the other two deliveries, this was a first baby so we could expect the second stage to take a bit longer. The lady was very well controlled and pushed really well, so that in actual fact, the baby was delivered within 10 minutes of us being able to see the head. So at 6.15 I had my third delivery, this time another baby boy. As with before, we checked over the placenta but this time I didn't need to rush off anywhere else. 

Of the three, the one that obviously meant the most, was the couple I'd been supporting throughout my shift. I got a much better experience of the progress, signs to watch out for and how to encourage and support women. When I finally sat down, I had a complete head rush and needed 5 minutes just to gather my thoughts a bit. It was a complete adrenaline rush and with three more nights to go...I am feeling slightly tired at the thought if they are to be like last night. However I loved it! I am hoping tonight that I get to have the journey of support through labour, as well as the delivery again. And perhaps slightly less running from room to room....and maybe even a break at some point. 

I am brave

Today I had a conversation with a fellow blogger StupidGirl about how brave it is to follow your dreams, prompted by her latest blog post. Many people I know think I am brave to enter the world of Midwifery but I don't think I am brave as I am just following my dreams of what I have always wanted to do.

However it took quite a lot of courage to tell people that I wanted to be a midwife. I worried a lot about what others would think and expected a negative reaction. As a result when I was younger and still at school, I didn't actually tell anyone it was what I wanted to do and I certainly didn't have the courage to actually apply. Then as an adult, it still took a bit of courage and a long time thinking about it before I would even voice the thought aloud. I can remember not long after my second daughter was born, talking to my Mum and voicing the thought aloud for the first time. I was worried that people would think it was post-birth euphoria speaking rather than anything else so if I dared to mention it I'd automatically declare I was waiting at least a year before acting on my hopes.

Every time I spoke to someone else about hoping to be a midwife, I'd wait for that negative reaction and it never did come. I got lots of positive responses in fact, and still do. Many friends and family have said to me that I will make a fantastic midwife. It would take more courage for me to say "I am going to be a fantastic midwife" than for me to take blood, or help to deliver a baby.

What was a brave step, was actually thinking to myself 'it's my life and I'm going to make the most of it, I'm going to follow my dreams'. And that is a brave step for anyone, whatever they are looking to do. For most of us, following our dreams, means some kind of sacrifice somewhere else in our lives. For me I am sacrificing my time with my daughters. I once said, I wouldn't work where I had to struggle to organise childcare in the school holidays or if my children were ill. So instead I have chosen a profession with possibly the most antisocial hours you can get. Why? What changed? Is it that my children are no longer my priority? Well it helps that they are no longer babies and require less of me now; but I have the belief that if I have to go to work and leave my girls, then I don't want to be resentful that I am having to work somewhere I hate, rather than be with them. I want to be working somewhere I enjoy the work, that gives me purpose. For me, that is Midwifery. I will be giving my daughters less time yes, but a much more fulfilled Mum. I believe in this way I will actually give them more, than I would by staying at home with them.

This is absolutely not a dig at any stay at home Mum's before anyone thinks it is. I was a stay at home Mum for 4 years and it's hard work. If my husband hadn't lost his job, I wouldn't have applied to Midwifery until both the girls were at school. My eldest is at school now and it won't be long until the youngest starts Nursery but it's meant a lot to me that my husband has been the stay at home parent for them. He has been a constant for them, in a time when a lot has changed in their lives. I know I would have wobbled far more about applying without his presence at home. (and that's not a judgement on working mother's either)

If you've dreamt about working in a particular area, then just think about it a little more. We only get one life and our working lives are long - far too long to spend doing something you hate. Just take a look at what you'd need to do to follow your dreams? Do you need to do a course? Can you study in the evenings? Just see if it's possible...even if you do nothing about it for now. Be brave and take a step....dip your toe....dare to dream...

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!

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?

Breastfeeding - my experience

Those that know me know that I am still feeding my almost three year old daughter and those that don't know this about me, may be surprised to know this. I feel passionate about breastfeeding and I know a lot about breastfeeding, positive and negative. Anyway I felt it was time to talk a little bit about my experiences, my opinions and my expectations; and I will say now that some of what I say may surprise you.

My Experience

When I fell pregnant with my first daughter and thought about how I planned to feed her, I merely thought "well I'll give breastfeeding a go but if it doesn't work out then I'm not going to beat myself up over it"....and I don't think that's a rare way to feel at all. I went to my antenatal class about feeding and noticed that there was a distinct drop in numbers attending. I listened dutifully to all the benefits to me and the baby and felt no real difference, and certainly no more prepared. I don't recall them discussing problems at all, though it is possible they did.

When my daughter was born, we did have skin-to-skin but in the immediate time following the birth there was no mention of feeding her. I certainly didn't have a clue what to do, or whether I should be trying to feed her or not. Anyway eventually someone did come to try and help me to breastfeed, I have no idea whether or not she was a midwife or maternity support worker. She certainly did her best, but my boobs would challenge most I think, as they are on the large side. Anyway she did manage to get her latched on but she didn't feed for long, and just wanted to sleep. Overnight she was very unsettled and I did my best to feed her but had no idea whether or not I was doing it right and come the morning I asked the midwives for some support. They did their best but she just didn't want to feed at the time they were able to help me, and when she did feed it was only for about 5 minutes. The midwives in the morning wanted me to stay a bit longer and get some more support with feeding, the afternoon midwives discharged me home. Did I feel confident? No, but having said that, I wanted to go home because I didn't feel that I was getting the support I needed whilst I was there anyway.

Over the next few days I gradually got sorer and my nipples cracked and were bleeding. I dreaded every single feed. However if someone suggested I switch to formula, I was like a stubborn child, I dug my heels in and was determined that it wasn't going to beat me. It was at this time, I actually discovered how much being able to breastfeed, mattered to me. I couldn't tell you why it mattered all I know is that it did. At that moment I certainly didn't give a monkey's about the health benefits, and I certainly wasn't thinking that formula was evil; I just knew that I wanted to breastfeed. Even now I can remember how determined I was whilst at the same time, I sobbed through every feed, and curled my toes.

Before I scare anyone who hasn't had children off breastfeeding for life....I would like to add that it changed very quickly - once I got the right support. I've actually already mentioned the inspirational midwife Annie who corrected my positioning and helped me on the road to pain free feeding. I saw Annie at home on day 5, and attended the breastfeeding group the same day. By the time I returned to the group a week later, the pain was gone. With my eldest daughter I went on to be pain free for the remainder of our breastfeeding journey which was ended by her when she was 13 months 1 week old. I attended the breastfeeding support group every week.....ok I wasn't experiencing pain but I did feel like I needed support. I made a lot of friends at that group, some of whom I consider amongst my closest friends now, one of which is in fact my second daughter's godmother. Having friends that had experienced the growth spurts, the distracted nursing child, the sleepless nights was essential.  Of course some of things are nothing to do with breastfeeding, but neither were the conversations about our husbands or families! The point was, someone had always had the same or similar experience and it meant you didn't feel quite as alone. At the time I was grieving the loss of my brother, who had died when my eldest was 10 weeks old; and whilst many of them may not have known that, they helped me more than they could ever know.


With my second daughter, I didn't anticipate any problems - after all, I had attended the group for well over a year, I'd already breastfed one child, I knew about all the problems to look out for...what could go wrong? Well...my daughter hadn't done all those things and she needed to learn how to feed, even if I didn't. There were no major problems, but boy did she have a strong suck on her and I experienced a couple of days of soreness as a result. When she was weighed on day 5, she'd already gained 13 ounces, so there was nothing wrong with her latch.

Over the coming months we experienced reflux , breast refusal, biting, mastitis and even a fairly long period of time where she would only feed from one side. I still have no idea why she only fed from one side; there seemed to be no real reason to it. She'd refuse to feed completely when she was teething but we invested in an amber teething necklace which seemed to do the trick. I was once a sceptic when it came to these alternative methods but the one and only other time she refused to feed, my husband had forgotten to put her necklace back on after her bath. The group helped support me, in that I knew it was quite common for babies to refuse to feed when they were teething, and that it was normal for different babies to react in different ways. With my first daughter, we'd never known she was teething, we'd just suddenly realise she had a new tooth.

When people found out that I had breastfed babies with teeth, they would always ask me about biting and doesn't it hurt. I have been bitten, and in all honesty, my second daughter once bit me so hard it drew blood. Not once did it occur to me, to stop breastfeeding because of it. I dealt with it in the same way I dealt with it any time she did something naughty. I told her very firmly no, and put her on the floor. She'd yell and cry, and I'd pick her up, tell her firmly not to bite and we'd continue. I'd like to say I only had to tell her once but it wouldn't be true. However I also learnt the signals for when she was considering biting, and the continued consistent reaction from me, ensured that it was soon a thing of the past; and she certainly never once bit me as hard again.


The couple of times I had mastitis, I was lucky in that I knew the signals and I was able to beat it becoming a more serious issue by feeding, feeding and feeding some more. I'd use a variety of positions to ensure that all the ducts were emptied properly. Again I am grateful to my attendance at the group, for knowing just how to handle it.

If you've learnt anything from this blog post, you should have worked out just how much I value the breastfeeding support group; it should therefore come as no surprise that I went on to become a breastfeeding mother helper and along with a friend, facilitated the group. I was awaiting training to become a peer supporter but I actually got my place at University before that happened. I did however attend the monthly training meetings with other mother helpers and peer supporters so I gained a wealth of knowledge about how to support women.

You might think from this blog post that I believe every woman should breastfeed...well you'd be wrong but I shall save telling you all about my opinion for my next blog post......

Inspirational Midwives

I have heard it said that along the way in my training it is likely I will see some bad practice, some ways of practising that I won't want to use and hopefully a lot of good practise. So it got me to thinking about putting down in writing what it was about the two midwives that I know, that inspired me so much, so that when I am suffering from a lack of confidence I can look back and read it. Of course it will be hard to convey exactly why they are so inspiring in writing but I shall do my very best. Those that know me and are local to me will know exactly who I am talking about but obviously I need to keep this confidential so I shan't be mentioning their names - I shall call them Jo and Annie for the purpose of this post.

I first met Annie when my eldest daughter was about 5 days old. She visited me at home to perform her heel prick test and she unfortunately had to come back and repeat it when she was 9 days old as she just hadn't bled well enough. I opened the door to her and cried with relief at seeing her. Now I shall talk in more detail about breastfeeding later but on day 9, I was at the end of my tether with breastfeeding. I was sore, my nipples were cracked and bleeding, I was incredibly engorged and I had a baby that wanted to be constantly feeding. Annie helped me to get her latched properly, and encouraged me to attend the breastfeeding support group later on that day. So later on that day I managed, somehow, to get myself out the door and down to the group. I shan't bang on about the group now, as I will cover it in more detail when I talk about breastfeeding, but Annie ran this group so amazingly well. She'd manage to balance supporting women, without ever judging them or pressuring them. She knew when it would help for someone to have a peer supporter provide one on one support and when someone needed more. When Annie ran the group we had a thriving membership, sometimes there weren't enough chairs; yet when government funding was pulled back, it meant she was only able to drop in on the group when she could, and the running of the group fell to the peer supporters themselves. Whilst the peer supporters did a fantastic job, the membership dwindled considerably. It was down to Annie and that group that led me to breastfeed as long as I did, as well as myself of course.

I can't remember when exactly I first met Jo as she'd sometimes come along to the breastfeeding group, though that was more Annie's domain, or whether or not it was at the  Baby Massage class that she ran. Jo has a wealth of knowledge on many many subjects not just midwifery related and I believe she has recently completed her Masters.

Together Jo and Annie ran the antenatal group/drop in. They were much like the antenatal classes run by the hospitals in some ways but far far better. They would cover all the usual topics you'd expect at, such as pain relief, positions in labour, instrumental deliveries, episiotomies etc. However what made this group so fantastic is that there was no limit on how often you attended. When I fell pregnant with my second daughter, I attended early on following some bleeding I had and then more regularly from around 28 weeks. It meant that you got to know the others that attended, some would be further along than you, and some would be earlier in pregnancy. When I attended the hospital classes when I was pregnant with my first daughter, we had one of those awkward get to know each other games and everyone was uncomfortable. At drop-in, as I shall call it, we did always introduce ourselves and although it was always a little bit uncomfortable, it got it over and done with, not to mention once you'd been a few times you found it easy. It also gave you a chance to say what had been going on with you that week, to raise something that might be worrying you, to moan about work or relatives. And it always felt like someone else had been through the same or was currently experiencing the same and that made for a very reassuring environment. So Annie and Jo provided this opportunity to access the information we needed, time to speak to a midwife but also time to speak with our peers. Separately they are both brilliant but together they are the best!

When I fell pregnant with my second daughter it was only natural to me to book with Annie. I saw her every week at the breastfeeding group and I felt so comfortable with her. Throughout my pregnancy I saw either Annie or Jo and got to know them both so much more. They gave me the confidence and the information to choose a home water birth. It was the ultimate joy when it was Annie and Jo that were present for the birth of my 2nd born. My first daughter was delivered by the midwives, my second daughter was delivered by me. Annie and Jo helped that to happen and in the case of a normal birth, this is how it should happen. The best part of this is, it's not only me they have this effect on. Amongst my friends, I can see how many they have empowered in their births....whether they were home births, Cesarean sections, instrumental deliveries or inductions....Annie and Jo inspired them all.

If I can be half as good a midwife as either of them, I shall be proud. I feel honoured to have known them, and words can't describe how I lucky I feel to have had them at the birth of my second daughter.

An unexpected pain

Anyone who has lost someone they love will know what I mean when I talk about the occasions where it hits you smack in the chest with a reminder of who you have lost, completely unexpectedly. There are of course the days that you know will be more difficult; the anniversaries, the birthdays, special occasions. You also know sometimes from the moment you wake up, that today is going to be a bad day, where the ache of missing them is as bad as the day you lost them. People tell you it gets better with time and that is both true and a lie. It's true that the fog lifts, and you are more able to function with every day that passes. However it's a lie that the pain lessens....at least that is the case for me.

I feel like I've started this post a little back to front as I am sure I have readers that don't know my history. My brother died in May 2006. He had a brain tumour that he just couldn't beat, despite his very best efforts. In spite of the fact that he'd been ill for some time, and we'd been told there was no more they could do, it still hit like a sledge hammer when he died. His wife had given birth to their son just two days previously, whom he sadly never met and it felt incredibly unfair. At the time, my eldest daughter was just 10 weeks old, and my sister's youngest son was just 8 months old so I don't know whether or not that made it feel worse to us, that he never got to meet his son. I have a very treasured photo of my brother holding my daughter but at the same time I almost feel guilty about having it at all. I could talk on and on about my brother - about his qualities and his faults but suffice to say I miss him just as much today as I did on the day he died.

Today at Uni I had one of those sledgehammer moments where the pain hit me hard in the chest completely unexpectedly. We were sat in our Ethics seminar talking about ethical decisions and one of the topics under debate was the case of Diane Blood who went to court to fight for the right to use her deceased husband's frozen sperm in order to conceive. The issue of consent was discussed and the fact that her late husband had not given consent for his sperm to be used if he should die but he also hasn't specified that he wouldn't want it to be used. When my brother was first diagnosed with a brain tumour and he and his wife knew that he was going to have chemotherapy, they made the decision to freeze some of his sperm knowing that they were planning to have a family. It is now an automatic part of the "service" to ask whether or not consent is given for the sperm to be used in the event that they pass away. My brother has given permission for it to be used so my sister-in-law will never have to fight for her rights there. However there are still a number of issues surrounding her actually using it so I know that it will never be an easy nor straightforward decision for her.

Anyway sitting in class today and listening to these debates going on around me on this topic; the rights of the deceased husband's parents, the rights of the children, the rights of Diane Blood. It hit me bang in the chest, that it could easily have been a conversation about my brother and his wife. Due to the fact that I didn't know my fellow students before beginning the course, they of course had no idea about my brother. Actually come to think of it, I don't think many people know about his frozen sperm....and why would they? Is it anything to do with anyone else?

It's made me think about my brother obviously but it's also made me think about the fact that we all bring our own histories and it isn't always obvious what someone has experienced. I believe that no-one should be taken at face value and that our experiences shape us and our opinions on things. Sometimes it is good to challenge yourself and think about why you think what you do? Where has it come from? If you explore it more deeply, is it what you truly think? Just to put this into perspective; I grew up believing that all terminations were wrong. I had never really thought about why I felt like this - was it my upbringing, my religion, how I really felt? Ultimately of course, I can only make a decision about what is right for me, and as a midwife, I need to be able to support women in their decisions without judgement. Therefore how I feel is somewhat irrelevant, providing it doesn't affect the care that I give. And that goes for anything not just terminations.

I feel a little like I have rambled my way through this post but I would like to share this very precious photo of my brother David, holding my daughter.