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!

A weighty family matter

Tonight I shall continue the story of my sister and her life - my last post finished with the birth of her son and a mention of her depression. 

In the months following the birth of my nephew, my brother was diagnosed with a second brain tumour and began further treatment, Christmas came and went, I gave birth to my first child, my brother's tumour stopped responding to treatment and shortly after the birth of his son, he lost his fight for life. My sister, sister-in-law and I used to meet up weekly with our babies. We'd have lunch, chat and try to be a comfort to each other. We were all grieving in very different ways. I don't really remember much of that time, lost in that haze of bereavement but I know there were times when we laughed and times that we cried.

During this time my sister's depression was increasing and her dependency on others was also increasing. She was drowning in grief and it wasn't just grief for my brother but also for the life she once had, the life that she thought she'd had, the happy daughter that had been stolen from her, the security that she'd once known. My parents went away and my sister's dependence switched heavily to me and my sister in law and lost in our own grief, and trying to deal with being parents, we didn't handle it very well. We argued, over something ridiculous really, but that afternoon my sister attempted to take her own life. I will be forever grateful that she didn't succeed that day, and forever grateful to those that helped me and her. It took me a long time to forgive my sister for what she'd tried to do and for me to gain more understanding of depression and helplessness that she must have felt. I can remember the relief that I felt when I collected my parents from the airport, that it wasn't my responsibility anymore. I'm not very proud of how I handled things back then. Over the coming months my sister had counselling and she got better. It wasn't a sudden thing, it was a gradual process and sometimes she'd have backward steps along the way. The good days eventually outweighed the bad. Time passed, we healed but we continue to grieve and that will never change. My sister has a new partner now and life has changed a lot from that dark time. 

Whilst my sister was battling the dark cloud of depression, my eldest niece was fighting battles of her own. She'd fought her father in court and "won" but the scars left behind were far deeper. It wasn't a simple case of getting him behind bars and that was that. She was entitled to counselling from the NSPCC because of her father but she wasn't able to have it until after the court case. It took a year for it to get to court so by the time she went to counselling, she'd reached a stage of locking everything deep inside her. She was too old for a child counsellor and too much of a teenager to really open up to anyone new. When she turned 18, we discovered she had an eating disorder. She's now 21 and has just recently been admitted as an inpatient into a unit for people with eating disorders. My sister is documenting her experiences in a blog of her own http://psychomum-todaystheday.blogspot.com/ so I'm not going to do the same. Life with someone with an eating disorder puts more pressure on a family than I ever imagined.

I mentioned in my first post that my sister fell off her pedestal for me when I was 12 years old. And I am sure I have raised some memories for my sister that have been difficult, she may well be wondering what I think of her now. She has faced a parent's worst nightmare and she has always been there for her children even when they have pushed her to the absolute limit. I have only touched on some of the things that she has faced. She doesn't consider herself a strong person but she is one of the strongest people I know. When I was 12, the sister I held on my pedestal was not really my sister but just who I imagined her to be. My sister is not perfect, who is? She still on occasion battles depression but she's winning the fight. I am proud to call her my sister. I am proud of how she has handled things, especially the last few years. Life has dealt her a difficult hand but she remains big hearted, generous, kind, and steadfastly loyal to her family and friends. She is an amazing person and I am honoured to be a part of her life. So sis, chin up and lets take on the next battle together, hand in hand. 

Part 2

It's possible I may have concerned my sister with which direction this series about her and her family might take but she need not worry, all will become clear. However in order to alleviate her worry, I have decided to continue the tale this evening. 

Yesterday I told you how we found out that my niece had been abused by her father and our lives changed forever. Naturally the police and social services were involved, however it took over a year to get her father behind bars. During that year, we rallied together as a family but it was almost too big for us to handle. During that time we first discovered that my brother was ill, and I was planning my wedding. My sister made the arrangements to sell the house that they had once shared as there was no way she could afford it on her own and started the wheels in motion for divorce.Now I get a little hazy as to the order in which things happened but during that year my sister sold the house she had once shared and her ex-husband halted the sale at the last moment, despite being in prison at the time. The result instead was that the house was repossessed but even that was not the process it should have been. As you might imagine with all this going on at the same time as my brother being desperately ill, my niece struggling with everything that had happened to her and the court case at which she testified, life for my sister was incredibly stressful and quite frankly awful. I was really quite worried about her at this time - she had some friends that I just wasn't sure about and she was going out a lot, drinking a lot. Frankly though it was nothing to do with me, there was nothing specific to worry about and goodness knows she needed the break. Everything just felt a little bit crazy. And then she discovered she was pregnant and it was as if the baby was sent to bring her life back on track. It might seem crazy to some but I truly believe that this baby came for a reason, despite all the odds. He came to give her hope again and to remind her of the future still there waiting. That it wasn't all hopeless as it all must have seemed. 

Life that had been so crazy seemed to settle back down. She still had the repossession to deal with and as I said that didn't happen as it should have done. Everything took a long time to happen, longer than it should have done. There were no guarantees that she would be housed, that she could be initially placed in a bed and breakfast with her three children, whilst pregnant. Thankfully when the day finally came, she was housed and by some miracle she was housed directly opposite my house. That evening her waters broke and the next day her second son was born. I was her birth partner and that day is very precious in my memory. I was already pregnant with my first daughter at this time, and my sister in law was also pregnant and I was looking forward to us all having babies so close in age to each other. 

At this time it felt to me like life was on the up, or at the very least was settling to a new kind of normal. My sister was beginning a new life which seemed more hopeful than it had just a week earlier, my brother was doing well, I was excited about my new baby...life was full of hope. The truth was very different - my sister was battling severe depression and my brother was shortly to be diagnosed with a second tumour.