Working in the community

Before Christmas I was working in Community which I do love. I particularly like it when I see women before and after the birth of their baby, or to see women on their first day home and then to see them when they are being discharged. In both situations, I have witnessed many changes in the women. I have witnessed the nervous woman become a confident mother, and I have witnessed the confident professional become very unsure and lost when faced with a tiny helpless baby. Babies are certainly unpredictable and it doesn't matter how many books you read before they are born, you simply can't be fully prepared.

One of the most common questions to be asked as a Midwife is "is this normal?" - this might be during pregnancy or after the birth but it gets asked a lot. 99% of the time (a guess, I haven't sat and worked out a statistic)  I would say yes, that it is perfectly normal. Babies are born with their own personalities and all we can do is respond to their needs to the best of our abilities. In the early days this often means trying to guess at what they need...mentally going through the checklist - hungry? nappy needs changing? too hot or too cold? tired? It's all guess work really until you can begin to learn your baby's cues.

Frequently new mothers ask about how to get their baby to sleep in the moses basket/crib/cot...anywhere rather than lying on Mum. Don't worry I did the same myself, in fact I think I spent the first 2 years of my eldest's life wondering and worrying about how to get her to sleep anywhere but near or on me - she had to be in contact in some way, whether lying on me or just having a hand on me. Generally I advise new mothers to cuddle their babies...shocking I know...but the baby has spent 9 months inside Mum, able to hear her heart beating as a constant sound, and never before having experienced hunger, temperature, gravity and yet we expect babies to suddenly sleep by themselves. Birth is a shock to them and they need reassurance and comfort. I also advise trying putting something that smells of Mum in the crib, warming the crib with a hot water bottle (ensuring to remove it before baby goes in) so it's not suddenly cold on their back, giving baby to Dad to settle for sleep, a slumber bear if they can afford one but what works for one baby won't work for another, and sometimes what works one night won't work the next, and sometimes it feels that nothing works at all. It can simply be a case of give it time...it certainly was the case with my eldest daughter. My younger daughter was far easier - she'd sleep anywhere! I certainly don't believe it was anything I did that made her more likely to sleep, just that she was born with that kind of personality. So give it time, cuddle your baby, try these things by all means but I promise that at some point, your baby will be able to go to sleep by themselves. I have been on the receiving end of such advice and at the time it felt like useless advice, the tiredness was relentless, and that even one more night was one night too many but I hope it brings comfort to know that yes this is normal for many babies.


I seem to have wandered into the realms of sleepless nights and generic advice but it is something that new mums ask about so often that I feel it's worth discussion. Certainly I feel that the lack of sleep I endured when my children were younger has prepared me well for night shifts as a midwife. As a breastfeeding mother helper, helping to run the group, the women that came along would frequently ask for help with sleep and their babies. We live in a society where "sleeping through the night" appears to be main focus, the ultimate goal, particularly in the early days and then with some desperation as time goes by. However if were simply to accept that babies wake in the night for an indefinite period of time, is it not easier to cope with? That actually the norm is not for babies to sleep through the night, but for them to wake regularly to feed and that at times they will sleep for longer and other times they will wake more frequently, such as during growth spurts which again are normal. I know that I found it far easier to deal with my second child's nightly wakings because I was prepared for it. I was still exhausted at times, and I still complained about it but I didn't waste energy trying to fight it or find an answer to it. I tried things to see if it helped but I didn't worry if it didn't, I just recognised that she wasn't ready yet. However I did have the advantage of not working at that time, I wasn't yet a student either. My eldest spent mornings at nursery so I used that time to catch up a bit and rest.  I think we have a tendancy in this country to try and push ourselves back to normal as soon as possible and actually we'd do well to stop and learn about our babies, spend time with them, allow time to recover from the birth properly...focus on what's important...not on having a show home, or getting out and about as quickly as possible, make use of friends and family to help out if you can. This is of course all very idealistic and I do realise that but I can dream, at least when I'm allowed to sleep that is. At the very least I think this is useful advice for those very early days....stop, rest, recover and cuddle your baby.

Photos courtesy of Marie Donn Photography

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.