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

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!