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/

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. 

Into delivery suite I go...

So here I am, a second year student and I've just started placement on Delivery Suite. On Sunday night I had butterflies in my tummy, and I was really nervous about starting placement this time. In part I think it's because wearing my second year badge, means I am meant to know stuff. Of course I do know a lot more than I did this time last year but there is still that feeling that you are faking it and soon someone will discover you don't know anything. It's a bit like the feeling that you are playing at being a grown up when you have children...I am sure some of you know what I mean.

Anyway I had my first shift on Monday and I felt like my head was full of cotton wool at the beginning of the day. It's been quite a while since we were last on placement and I had to get myself back into mindset and remember how things were done....mainly the documentation. Also this is the first time I've worked on Delivery Suite, having worked in the Midwife Led Unit before so I'm learning how things are different. The main difference is that there are far more high risk women being cared for which means that the CTG machines are used for monitoring, in some cases continuously throughout labour. Then there are the women who are on drips for inducing labour, women with epidurals, women with pre-existing conditions that need to be monitored, women carrying twins (or more), women who have had bleeding during pregnancy, women with high blood pressure, and anything else you can think of really.

In comparison with the midwifery led unit, delivery suite is more fast paced, and busier. There is always something going on. The doctors are also far more involved with care and decision making. One of the things I have learnt this week, is how quickly things can change, and how quickly the staff can move when they need to. For low risk women, the constant monitoring is not needed, but once you begin to intervene and various drugs are used, there can be a reaction to that drug, and it can be very sudden. However with the monitoring that is used, the response to any reaction is swift.

I've watched One Born Every Minute and how the midwives are portrayed - sat in the office drinking tea and eating cake whilst women labour on their own. I have to say this is definitely not my experience. Where I am the midwives spend the majority of the time in with their women. They may grab a cup of tea at some point, but often they don't get the chance, and I don't like to think how many midwives miss getting a lunch break because it's just too busy. Would you not agree that it would be a safer and happier environment for all if there were enough staff to ensure they got a break? It's not that I think it's unsafe where I am fortunately but I can definitely see that there would be a huge benefit to all, if there were more staff.  You can't predict who will walk the door, with what "problems" so you always have to be prepared for anything. Delivery suite needs midwives who work as a team, supporting each other, alongside the doctors, anaesthetists, maternity support workers, cleaners etc... Everyone has a vital role in delivery suite and communication is essential.

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?