Category Archives: pregnancy

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. 

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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. 

Baby Whisperers Please Pipe Down

  
People who know me well know my feelings on so-called ‘parenting experts’. I have been known to ‘relocate’ a certain publication which we midwives know and loathe to the ‘Facism and Nazism’ section in Waterstones (other book retailers are available) and would actively encourage any of you reading this to do the same. 

It’s not that I have an issue with people offering advice, it’s a fact of life, especially when you are a new parent, and some of it you might even take! The issue I have is people who prey on the fears and insecurities of these new parents by offering them a solution to their perceived lack of knowledge, or a becon of light to guide them through the fumbling darkness in the form of….a book!

The idea of these books/baby bibles or whatever you wish to call them is that they tell you exactly what you should do, at what time and for how long etc and eventually you will end up with what television presenter Eamonn Holmes and his partner Ruth Langford described, after following a particular regime, as a ‘clockwork baby’ (which was, to them, a good thing).

Gina Ford published a strict regime in her “Contented Little Baby Book” encouraging parents to break their day down into five minute slots in order to get the newborn baby into a routine as soon as possible. Of course once you have actually had a baby you realise pretty quickly that achieving anything in five minutes is nigh on impossible (unless it’s a shower!). 

The baby should be woken and fed at 7am, parents fed by 8am then the baby fed (in the nursery!) every 4 hours until the last feed at 6:15 whereby parents must not, under any circumstances, make eye contact with their child in case it gets excited! Seriously?

We, as a family when our first born child made his entrance into the world, failed miserably at the first hurdle. Rather inconveniently our son was not born with the ability to read so had absolutely no idea what he was supposed to be doing in regard to this regime. What he did seem to know, rather instinctively, was that he needed to feed more frequently than 4 hourly and certainly had no intention of fasting after 6:15 no matter what Gina Ford said! 

Eye contact was unavoidable. Gazing into his eyes became a favourite pastime in our household and it soon became apparent that he was in charge and we, as his parents, were simply put on this earth to to cater to his every whim. Resistance was futile. Once we accepted and embraced that everything fell into place.

Babies are not born with the ability to manipulate. They only know what they need and when they need it. They are actually very accomplished communicators, you just need to tune in to what they are telling you and trust me, they have so much to say.

Watch your baby, talk to him and watch him mimic your facial expressions even from an early age. He is constantly learning from you and the early stimulation he receives from you will set the stage for how he learns and interacts with others in later life. Loving interactions with caring adults strongly stimulate the brain causing synapses to grow and existing connections to get stronger. Connections that are used become permanent, those which are not used ‘die’ and are irreplaceable. 

Gina Ford also advises parents to leave their child to cry for up to an hour so it will learn not to always expect to be picked up.  Why would we want our child to not expect to be comforted if he is upset or needing reassurance? The child that is left to cry doesn’t stop because he has suddenly acknowledged the error of his ways. He has stopped because he has become exhausted and realised that crying is futile because nobody will come anyway. 

Parenting is one of the hardest ventures any of us will ever embark on. The pressure to be perfect is immense, after all if we get this wrong we risk our child’s future happiness/life chances/mental health…etc but do we need perfection and if so, who gets to decide what perfect actually is?

I have encountered so many parents who have been reduced to tears and left with huge feelings of inadequacy because they have been unable to get their two week old infant into a routine which includes sleeping through the night, and are having nightmares about their child becoming a future delinquent because they ‘overslept’ and gave the 7am feed at 7:30. 

Enough! 

Parenting means to prioritise your baby’s needs above your own. It’s tiring and demanding but nobody said this parenting malarkey was easy. Feed your baby when he is hungry, cuddle him close, sing and talk to him and enjoy these interactions. These days pass so quickly and you will never get them back. Trust your instincts, and his. You know what you need and so does he. You know your baby better than anyone else and YOU are the expert on your child. Babies do not need routines, they need loving, responsive parents who nurture confidence in their child by providing the assurance that they are there to catch them when they fall. 

Baby Whisperers have too much to say and they need to pipe down. 

Why I stay in the job I love…

I read an article recently, actually I’ve seen it several times, popping up on my social media feed as friends and colleagues have shared it with their followers etc. 

The article is by a midwife with 8 years of experience who has been forced to resign because of what she feels is a culture of stress and bullying and has begun a new career in risk management. 

I wish her well but I’d like to share a few thoughts with you now, on why I choose to stay in this profession. 

I qualified in 2000 having been a haematology nurse before that. I hadn’t had children when I started my midwifery career, believe me becoming a mother changes your perspective on pregnancy, childbirth and (especially) breastfeeding. I felt so safe as a student midwife in Norwich. Part of a team, surrounded by wonderful midwives who’s practice I wanted to emulate and who really wanted to teach me how to become an expert in normal birth. I’ve stayed in touch with many of them over the years and hope they feel that I’ve lived up to their high standards and professionalism as well as compassion and caring. 

The role is not always easy, shifts can be horrendously busy, there are times when it seems like there will never be enough staff. It’s tiring, challenging, emotionally draining and very demanding but here’s the thing.

I work with an INCREDIBLE group of women. 

Wives, mothers, daughters, sisters, all here for a common goal. To support women, mostly strangers before they encounter them on this journey, as they embark on motherhood. 

They care, boy do they care. 

They want that woman to achieve the birth she hopes for, they will fight anyone who enters the room in order to protect the birth environment if they need to and they will watch over her whilst she drifts in and out of sleep in between contractions thinking of their own experiences of childbirth in the spirit of sisterhood.

These women supported me as I gave birth to my own three children, they watched me transition into motherhood in front of their eyes and I would still trust each and every one of them with my life and that of my children.  I love the fact that I have the pleasure of seeing the women who brought my children into the world every day and they see my children growing up. 

Don’t get me wrong, we’ve had some dreadful shifts. Times when all we want to do is just put our coats on and go home because our shift has ended and so what if it’s short staffed?? But we don’t, we stay and make sure everyone is safe because that’s what you do when you care. 

I’ve seen midwives break down and cry after delivering the “born asleep” baby of the woman who they stayed after their shift to care for because they’d made a connection. I can tell you that we still hold our breath, in the faint hope that there may be some mistake, that this beautiful, precious child will take a breath and cry at birth because if wishing could make it happen it surely would. 

I’ve watched the expressions on the faces of my colleagues as we’ve heard women in the second stage of labour, the sounds turning to that first cry of a newborn baby, smiling to themselves in secret relief that another baby has safely made their way into the world but always ready to rush to the side of the midwife who has requested help. Calmly co-ordinating themselves without the need for instruction to ensure everything and everyone that is needed is on hand. 

And the women, and partners, who I truly feel honoured to be able to support during the most life changing event they will ever encounter. The wonderful conversations we have during the course of our meeting. Some of the women I meet have overcome the most horrendous personal circumstances to get where they are, some have been gifted with the most amazing lives but each of them have a story and they fascinate me. There can surely be few people on earth who are lucky enough to witness a couple become a family in front of their eyes. That beautiful moment when a mother first sets eyes on the child that has emerged from her body and the look that is exchanged between her and her partner. Those who have seen it will know exactly what I mean. 

I’m not trying to paint the picture that everything is perfect. There are many reasons why midwives are leaving the profession in droves, but, for me, there are many more reasons to stay.