Category Archives: Midwifery

Why compassionate care should begin with each other.

I haven’t posted in a while. Work and home life have been equally demanding and I think it’s good for us to take a step back every now and then and gather ourselves. 

Over the past few weeks I’ve been questioning why as midwives we are able to demonstrate such kindness and compassion to the families we work with yet when it comes to our colleagues we don’t always find it so easy.

I think we can all be guilty of focussing on our own clinical areas with the belief that we have the greatest challenges within a unit but in truth that is rarely the case. Every area has its pressures, some just manifest in different ways but it is all relative and a lack of understanding of a persons role should not lead to an assumption that they are somehow less important or hard working than you. 

It can be difficult,  on the days when the workload is intense, to remain civil to the person who has just asked you to accept another admission into the ward, or the agency who have just contacted you for information at the very moment you have logged out of the system you need to access, but try we must because who knows what sort of a day that person too is having?

Throwaway comments, especially when overheard, can be incredibly wounding and leave the person on the recieving end feeling sad, disheartened and distrustful of the perpetrator. What is said cannot be unsaid, even in the heat of the moment.

My grandma always used to say to me “taste your words before you spit them out”, in other words think before you speak. I can’t say I have always practiced this and there have been times when I have been just as surprised as everyone else by what has come out of my mouth! As I have got older though I have gradually learned to just pause before responding to something I may find as unreasonable. 

The other premise my grandma used was to ask 3 questions before responding.

1) is it true?

2) is it necessary?

3) is it kind?

If the answer to any of those questions is “no” it is best left unsaid.

The NHS I work in now has changed so much since I started back in 1991 as a student nurse at The Royal Free. More is being asked with less resources and fewer staff which is why now, more than ever, we need to take the time to care for each other. Kindness goes a long way, as does respect and courtesy, and that shouldn’t be dependant on banding or any other hierarchical notions. 

The ward housekeeper is every bit as important as the chief executive of the hospital. Without either the organisation would grind to a halt and I wholeheartedly agree with Sir Richard Branson when he says that if you take care of your employees they will take care of your clients. 

Nurturing a culture of kindness has to be a priority in today’s NHS and can have a huge impact on the lives of those around us. Our days are happier when we give people a bit of our heart rather than a piece of our mind. 

Advertisements

Tackling a Four Letter Word

  

I’ve been reading a lot of interesting posts on Twitter lately discussing a four letter word which is rapidly becoming the elephant in the room as far as providing maternity care goes so I thought I would have a go at trying to give my perspective via a forum which isn’t limiting me to 140 characters.

The concept of RISK is emotive. Being ‘risk averse’ seems to be something which is considered negative, a form of defensive practice and, from some of the posts I’ve been reading, not something that midwives should be supportive of if we want to be considered truly supportive of the birth process. However, The Cambridge English Dictionary defines the term as being ‘”unwilling to take ​risks or ​wanting to ​avoid ​risks as much as ​possible” which I have to admit I feel comfortable with and, should anyone wish to evaluate my practice, would be happy with that description.

Alongside the subject of risk is the statement I see repeated with almost the same frequency that ‘a healthy baby isn’t all that matters’. To contextualise, the point being made is that outcomes should also be measured by the mothers experience of birth and not the condition of baby alone but there is the risk that this could read, to some, that the experience is more important than the outcome and that is wrong.

Being risk averse does not mean the primary focus is on the baby, there are many variables involved in a good outcome. A healthy baby does not mean that the mothers wishes have been ignored, to suggest that the two are mutually exclusive is irresponsible and does nothing to promote trust and respect between families and professionals.

I liken the concept of risk management in pregnancy and birth to crossing the road. In both scenarios there is an identified risk: that statistically despite this being an everyday process, there will be occasions where there will be an adverse outcome. That is a fact, not a scaremongering tactic, and we do women, their partners and their babies a great dis-service if we choose not to acknowledge this in case it prejudices the decision making process.

To minimise the chance of an adverse outcome when we cross the road we would need to identify potential hazards, for example the obstruction to the drivers vision which may prevent him from seeing us cross, or the 60mph speed limit which gives us less time to cross, and look for a solution which enables us to still cross the road, but in a safer place where the desired outcome of reaching the other side of the road in one piece has a greater chance of being achieved. The same can be said when discussing and planning maternity care, and in particular, place of birth.

Some women live on that quiet country lane which is quiet, calm and traffic is infrequent. She will have had a healthy, uneventful pregnancy and, after discussing the options of where to cross the road (or give birth) will have many options open to her where the outcome will still be the same, however she must still be aware of the fact that she cannot predict the rogue driver who may decide to make an appearance at the time she chooses to cross. Caution should still be applied, even on an empty road.

For the woman who lives near the motorway (or has a slightly more complicated pregnancy) the traffic may not be so calm, but she still wants to cross the road safely. The potential hazards need to be identified so that she can decide where to cross and it may be that the traffic is so heavy she may need to seek an alternative way of getting to the other side, however, there will be times when the traffic slows and even stops so that, if she is ready, she can make her way safely across without the help that is available.

To manage risk it has to be identified. Acknowledging it exists and looking at how to minimise it is good practice. Risk taking rarely saves lives except in disaster movies and patient safety should not be considered as the antithesis to patient choice. Good communication skills, knowledge sharing and respect all contribute to ensuring the two can work together in providing a positive and safe outcome for all. 

Sleep Deprivation: Why the postnatal period should not be an endurance test. 

  

I was involved in a discussion on Twitter the other day, reminiscing about the old days when babies were taken into the nursery at night and cared for by the staff on the maternity unit whilst mum was able to take advantage of the opportunity to catch up on some much needed sleep. Within seconds I was questioned (rather accusingly) as to whether I supported the concept of ‘separating mums and babies’! 

Actually nothing could be further from the truth. I think the mother-baby dyad should be supported and nurtured whenever possible when that is what the mother wants but establishing a secure attachment goes much deeper than just rooming in and promoting skin to skin.

Sleep deprivation is known to exacerbate mental health issues, occasionally with very severe consequences. Fit, healthy males have been known to suffer from hallucinations whilst undertaking the Royal Marine Commando Course whilst undergoing enforced periods of sleep deprivation to test endurance, and many fail. The very fact that we would treat something which is just generally expected of new mothers as an endurance test should speak volumes yet this is rarely acknowledged by health care professionals.

The subject of sleep needs to be discussed with women antenatally, especially those who may have pre-existing mental health conditions or identified as being at high risk of developing PND. Sleep is not a dirty word. It is a fundamental human need and is essential to promote mental well being.

Dads or birth partners should be a welcome addition to the postnatal ward. There is no golden rule that states all parenting duties should fall to the mother. Allowing partners to remain on the postnatal ward overnight ensures a mother is able to rest properly whilst her baby is cared for in the same environment, dads can enjoy skin to skin too!

Women should be encouraged to think about how they will protect their sleep, especially during the early days when establishing breast feeding (or not) or simply adjusting to new motherhood. It would be incredibly unrealistic to expect to be able to sleep through the night, but a plan to enable the new mother to have a few hours uninterrupted sleep during a 24 hour period can literally be a life saver. Friends and/or relatives can be instrumental in achieving this.

Midwives and health visitors are notoriously good at knocking on the door to perform a postnatal visit just after a mother has finally fallen asleep after a wakeful night then reminding her to ‘sleep whilst the baby sleeps’ as we leave. Co-ordinating these visits with a mother and her support network can ensure that precious ‘sleep time’ can be protected and she is able to sleep whilst friends or family take over with baby for a few hours.

24 hours of sleep deprivation can lead to symptoms of psychosis in healthy adults, similar to those observed in schizophrenia. Sleep deprivation also triggers a key biomarker in psychosis important in the research of anti-psychotic drugs and has been proven to lead to a re-wiring of the brains emotional circuitry. Is it any wonder women can begin to experience a significant deterioration in their mental well being when this goes on for much lengthier periods of time?

As health care professionals we must not be afraid to address the fact that, for some women, sleep must be prioritised. We are not interfering in the parent-infant bond by suggesting a woman think about a sleep plan in the same way we would encourage her to make a birth plan. Psychiatric disorders are a leading cause of maternal death according to the most recent MBRRACE-UK report (2014) and sleep deprivation has been identified as a contributory factor in many of these cases. Sleep should be considered equally as important as any other intervention necessary to maintain good physical or emotional health. If we want to be truly baby friendly we need to first achieve ‘mum friendly’.