Do you have a mental health problem?

This week at Uni we've been talking about post natal depression and mental health issues. It was unfortunate timing that the news about Felicia Boots hit the headlines. Or was it? I do think that post natal depression is not talked about enough. Depression is a stigma and not discussed as much as it should be. Allegedly Felicia did not take the medication that she needed because she was so frightened that the medication would affect her babies through her breast milk. This is not an uncommon event, although fortunately most women do not kill their children. Do you know which drugs are safe in pregnancy or to breastfeed with? No? Neither do I. However I do know where I can access the information to find out and I also know that in some situations, whilst one drug may not be suitable, there may be an alternative. Simply stopping a drug is not the best course of action. 

Felicia's case is truly tragic but there are so many others that need more support. Mental Health issues affect 1 in 4 people every year....so that could easily be you right? I know it was me. I've told you about when my brother died and naturally bereavement can be a large precursor to mental health problems. Personally I also was dealing with a variety of other difficulties in my personal life...as mentioned before, my sister's family life wasn't easy, but at the same time my husband had lost his job, we were struggling financially and at the time, it just felt like everything was going wrong. Usually an optimistic person, I became consumed with the thought that some people were just unlucky and no matter how hard they tried, their lives would always be miserable, and who was to say that wasn't me. I had thoughts of leaving my family....not of suicide, just of driving away and living somewhere far away from them. I decided I was bad luck and I would bring nothing good to them. Luckily I have a wonderfully supportive family and friends, and I sought help from the GP. I was immediately referred for counselling and given regular appointments with my doctor. Initially my GP was reluctant to prescribe anti-depressants because I was breastfeeding and he was unsure if they were safe. Encouraged my friends, I returned to my GP armed with information from the Breastfeeding Network http://www.breastfeedingnetwork.org.uk/drugs-in-breastmilk-information-and-factsheets.html and I was given the medication that I needed. Fortunately for me, the medication and counselling I had, helped me. I recovered without any major side effects. I was lucky. I am no longer in counselling, and I am no longer on medication. However it's also not something I shout about.

If doctors are afraid to prescribe the medication that people need then it's really no surprise that women are afraid to take it, in pregnancy or whilst breastfeeding. But where does this leave the women that so desperately need help. What about those women who have serious mental health issues such as bipolar disorder, schizophrenia, obsessive compulsive disorder, psychosis etc... The medication that they take can be essential to them being able to live a "normal" life. There are only 13 mother and baby units in the UK. This means that any mother requiring inpatient care for a mental health issue is more likely to be separated from her baby due to the lack of this vital resource. 

The NHS offers this page as advice for anyone worried about postnatal depression.

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/feeling-depressed-after-birth.aspx#close

I don't have the answers to the problem but I hope that I do remember to talk to women...to take that time and listen and ensure that they are getting the support they so desperately need. I will do my absolute best to ensure that women aren't stopping medication unnecessarily. I will encourage women to speak up if they are feeling down and I will encourage family members to watch out for the signs of postnatal depression. But this is something you can look out for too....with friends, family members, colleagues, neighbours. Not necessarily postnatal depression but any form of mental health issue. Let's break down this stigma and offer people the help they really need. 

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!

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?

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.

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.

Attitude and Stereotypes

Today we had a lecture about attitude and stereotypes and it really made me think about myself and the kind of person I am. I tend to think I don't conform to the norm and like to be a bit different. However as a female who is more than "cuddly" I certainly think I conform to the traditional image of a midwife. When my eldest daughter was born, I did tend to dress her in pink clothing; though it has to be said, I partially did that so that people would know she was a girl and this continued as she hadn't much hair until she was 2 years old.

In personality I think I am fairly atypical of female traits. I am sensitive, cry easily and wear my heart on my sleeve. I have a tendency to react first and think later - this can be both a benefit and a fault of course. In general I think I have a "good attitude". I mostly look on the positive side of life and am an optimist. However at other times I have a definite tendency towards a negative, pessimistic attitude. My self-confidence is not great and people don't always know this about me as I put on a face to hide it so I would say that is the more negative side of my personality. However when it comes to situations and life in general I am fairly optimistic. I also tend to try and turn situations around and find the positives in them where I can. I also like to think that I always try to see the best in everyone. This is probably because I don't believe that anyone is all bad and that circumstance, upbringing, finances etc. all contribute to who we are; not to forget that everyone is entitled to a bad day.

When I consider my home life I think I am a little less stereotypical. I have a house husband for example - that's definitely not stereotypical. My husband is responsible for the majority of the childcare, the cooking, the washing, and  the housework. My husband is not the type of man to be concerned with how people view him though.  I had however been a stay at home Mum for 4 years before I started the course. I don't think that is unusual, although it's not unusual for women to return to work either. Perhaps slightly more unusual is the fact that I used cloth nappies and a sling which which to carry them. Whilst these are growing in popularity, they are still the more unusual option.

When I was at school Take That were around for the first time and many of my friends were really into them. Me - nope I didn't like them at all! I was into Guns n' Roses and Pink Floyd. I liked to wear Doctor Martens and a leather jacket. So although I wasn't the stereotypical teenager in some ways, I was still conforming to an image of what a Guns n' Roses fan should look like. Not quite so much of an individual after all. These days I listen to what I like and if it's in the charts then great because they'll be playing it on the radio.

So what benefit is this to me in my training as a midwife? I don't fit into a "box". I am not stereotypical because no-one really is. Everyone is unique and an individual and as such the care provided to them needs to be tailored individually as well. As a midwife being able to see the good in everyone should only advantage me I think? Understanding that attitude can be affected by others is essential as well. If I am positive with a woman, in both my language and demeanour, then that can transfer to her and help her to be more positive too. It's important not to be judgemental as a midwife but we all make snap judgements on a daily basis. We make assumptions about what people are like based on their clothes, their appearance, their job. This shouldn't impact on how I look after women. I am most definitely not a saint or an angel, as midwives are sometimes portrayed,  but I do try my best to treat people equally already.

A week at Uni

I began the week feeling very nervous about my exam. I was glad to have no lectures on the Monday so I could spend the whole day studying. My husband dropped me off at the library straight after we dropped our eldest off at school and I got straight down to work. The first thing I decided to do was my drugs calculation test; as I wasn't concerned about it, I thought I'd get it out of the way. I was more nervous doing it, than  I expected to be so I made sure to take my time, read every question twice and double checked each answer. Thankfully I passed it first time so I could then forget about it.

Tuesday we had a full day of lectures and meetings which none of us really wanted, as we'd rather have been preparing for the exam. In fact there were quite a few empty chairs. We began the day with a cohort meeting although it was meant to be a skills lecture, we ended up switching the two around. The cohort meeting gave us an opportunity to raise any issues that had come up over placement, problems we'd come up against and also to celebrate our successes. It seems that the difficulties were things that had come up time and time before. There were quite a few girls that had had problems having their books signed off - that their mentors would repeatedly put it off, and then it would be too late. There also seemed to be a huge variation in the marks we'd been given. There is a mark guide and we'd been advised to explain that the mark scheme was based on us as first years and therefore we'd possibly need to push for higher marks if we felt we deserved it. Unfortunately some mentors would mark us as first years assuming the marking criteria would remain the same over the three years and wouldn't listen to any opinion given by the student. It certainly made me realise how lucky I had been with my mentor and how I'd been marked for my placement.

There was also some discussion about the attitude towards students from some of the midwives. It's very obvious those that are happy to work with students and those that aren't. Simply put it is an essential part of their job but like any job I guess, everyone has parts they don't want to do....doesn't make it easy for us as students however. We talked quite a lot about the different ways we had handled it and hopefully it will help us for our future placements.

We then had our skills lecture, personal tutor group meeting and finally a psycho-social lecture. It would have been far better to have had the psycho-social lecture at the beginning of the day as many people left by the end of the day, and I found it hard to concentrate by that point. Once we'd finished for the day I went straight to the library to squeeze in some final study for the exam. I must confess it wasn't very successful as I was very tired by then.

So Wednesday came and the nerves were fluttering. We were due to have a lecture for Values at 9 but I confess I skipped it in favour of some more last minute study. At 12 I made my way over to the room along with some of my colleagues. The exam was two hours long and afterwards there was the typical postmortem. I found it much harder than I'd expected in some parts and other parts were ok. I simply hope I have done enough to pass it!

The next couple of days were far nicer without the exam hanging over us, though we'll all be grateful in about 6 weeks when we get the results. We're already thinking ahead to our next assignment and also our next placement. And we're also beginning to think about our transition time when we can choose what we'd like to do for 3 weeks; well 100 hours. I've got a few ideas and it's a case of deciding which one to go for. Next year I think I would like to go and learn about fertility treatment and then potentially use that experience to follow through with my final dissertation.

Placement One - Done!

Tomorrow the first assignment is due in - thankfully I've already done mine and submitted it. I've since fretted over whether or not I've missed anything, whether or not I've submitted it correctly and so on. However all I can do now is wait and see so I am trying to put it out of my mind and concentrate on the other assessments I have coming up. I have begun on my next assignment already as it's a bit more challenging. I am grateful that I have until January to complete it.

The other thing I can do tomorrow is my online Drugs calculation test. The practice test has been open for a couple of weeks and I've done fine with it so I must confess to not being too worried. It is compulsory to get 100%  because in the real world when it comes to drugs, there can't be any errors. We get three attempts at the test, we can log in over the next two weeks to make our attempt and we get the result immediately....I think this is my kind of test!

However on Wednesday I have my first exam. I've been studying hard but I feel like each time I leave the library I know less than when I went in. I just keep hoping that some of it sticks. This is fortunately the only exam we'll sit this year and it's on Biology - probably my weakest area. The paper is split into two parts - the first part is 25 multiple choice questions; and the second part is the Midwifery specific question with a diagram to label and 4 long answer questions worth 10 points each. In order to pass we have to get 40% but obviously I'd like to get a better mark than that. This week I have been studying the pelvis - when I am in the car, I'm reciting the names of the bones and picturing the diagram in my head trying to match up the names with the image. I've also been studying fetal circulation before and after birth and the changes that occur. I've been looking at all the hormones and their effects during pregnancy. Tomorrow I am glad that I have no lectures so I can spend the day in the library studying hard although I worry that I don't have time to read up on everything that I want to. It's definitely a learning experience for the future....start earlier - yet I thought I started fairly early already.

I really enjoyed placement but I must confess to looking forward to going back into Uni now. I am looking forward to catching up with my cohort and hearing about their placement. I am particularly looking forward to talking with those who worked in the same area as me and with some of the same people. I am almost certain now that I am the only one in my cohort that hasn't made a "catch" of my own. I am trying hard to concentrate on the fact that it doesn't matter at this stage and next placement I will certainly do it, and plenty of times I am sure. Also I have had no problems in the end with getting my book signed off and I am thrilled with the result and feedback I have been given. However I cannot deny being slightly envious that everyone else has had their first delivery.

So now I am looking forward to Thursday - the exam over, the drugs calculation test hopefully passed. Of course we'll be back into the thick of lectures and seminars but with the next deadline a while away, it feels a little less pressured. Wish me luck for Wednesday - I have no doubt I shall post to let you know how I felt it went.