Fear

Becoming a parent can, for some, be the most frightening experience in the world. You can ask about others experiences, you can read all the books, you can look on the internet but nothing can really tell you what it's going to be like. It is quite normal for first time mums to focus on the labour that is ahead of them and read all you can on the subject or alternatively, completely stick their heads in the sand and not think about it at all. I was someone who had to read everything I could. For me, as a future midwife, as someone who has been through labour twice, as a mum who wonders what parenthood will bring that day, I wonder if I can help alleviate some fear? I certainly hope that I can, for women that I work with and with friends who are to become parents in the future.

Labour is certainly something that holds a lot of fear and it's understandable that it does because anything that involves pain, is something to worry about. Instinctively, as humans, if there is pain then there is something wrong. However labour is unique in that, it is the only time that pain is actually a good thing. If you are someone that has had a tough pregnancy, or you go overdue, or you've just had enough of waiting, you may even find yourself wishing for the pains to start. The one time in your life, you will wish for pain?

Television doesn't help of course...it gives the impression that when you go into labour your waters will break and you are instantly in agony. I'd hope that most people realise that labour generally takes longer than how it is usually portrayed on the tele. For most women, labour begins with mild, irregular pains. Many women liken them to period pains. You can breathe through them, you can walk through them, you can easily talk through them...not like they'd have you believe in Albert Square. They can be 10-15 minutes apart, they can stop for a few hours and then start up again. This is the main reason women are recommended to wait before rushing up to the hospital. Yes they hurt, some are stronger than others but as it's not a constant pain it's something women can cope easily with. The fear that can accompany those pains however, is what some women find difficult to handle. The not knowing how long it will last for, can be difficult to handle. And sometimes whilst the pain isn't that strong yet, it can still prevent women from sleeping or getting comfortable, and this can have an impact on how well women cope.

I believe that fear surrounding labour and birth should be handled at the antenatal stage, or perhaps pre-conception would ideal. I wholeheartedly believe, that in the delivery suite is not the place though. It's much more difficult to maintain normality when someone is terrified. It's not impossible and I have witnessed some amazing midwives who can calm the most frightened of women, and ground them, manage their fear, soothe them and make them feel safe. I hope to be this kind of midwife. I believe that the overwhelming fear that some women experience does sometimes lead them to choosing an epidural for pain relief. They don't know what to expect and how long it might take. Providing women with accurate information, and helping them to make an informed decision is vital. Being able to alleviate their fear is also vital. I have witnessed frightened women "choosing" an epidural and as someone pointed out to me, how can it be an informed choice when it is a fear based decision. Women should not reach this level of fear.

When I was pregnant with my second daughter, I attended an antenatal group, as previously mentioned in my Inspirational Midwives post last year, where I was given all the information I could possibly need to make an informed choice about where I wanted to give birth, my pain relief options and what to expect if things didn't go to plan. I always wished I'd attended the group when I was pregnant for the first time. What I find incredibly sad, is that group had to stop running due to a lack of funding. Those midwives inspired a number of women to have a home birth, who in turn inspired others to also have home births, and that cycle is still continuing, their inspiration still continues on. They gave women a voice, because they provided the information, they probably saved the NHS a lot of money because a women who knows what to expect, needs far less interventions, would decline unnecessary interventions. In an ideal world, the community midwife would be able to handle all fears about labour and birth during an antenatal appointment. Sadly there just isn't time - too many women and not enough midwives. Midwives constantly thinking about the next woman they have to see....it's not that they don't want to, it's more that it's just not possible.

Fear is the biggest barrier for a woman facing labour and birth. Time is one the biggest barriers facing the midwife. My biggest fear about becoming a midwife, is not having the time to be able to give women the care that they need, that they deserve and becoming frustrated with time constraints. I hope to remember the midwives who managed to give the time without neglecting others, somehow found a way to manage it. 

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?

What do women want?

I've talked quite a lot about the kind of midwife that I want to be but the other day I was considering the kind of midwife that women want? I am in the unique position of knowing a variety of women, who have all had very different labours and experiences, positive and negative, so I took the opportunity to ask them just how they felt about their births and how they felt about the midwives involved in their care. The response was very mixed, as you'd expect but there were some common answers that seemed to run through their replies. The responses made for very interesting reading, and sometimes very emotional reading.

It came as no surprise that the women wanted to feel listened to; that they were more than just a number and treated as an individual. It's a well researched fact that women in labour have better outcomes when they receive one to one care and yet this doesn't appear to be happening for all women. Their are midwifery shortages throughout the UK which places a huge impact on the services that midwives are able to provide and the subsequent experience that women will get. Although it cannot be denied that staff shortages are not the sole reason that some women do not receive one to one care and despite listening skills being highlighted as an essential requirement for any midwifery student candidate, it appears that some midwives have lost the ability.

The vast majority of positive experiences were during labour and planned caesarean births and the women spoke of calm, reassuring midwives who kept them informed. There was disappointment spoken of, if a midwife who had been present for their care, had come to the end of her shift and a different midwife had taken over. Again I was reminded of the importance of one to one care and how much of a difference it made to women.

I was particularly sad to read that for most women the postnatal care, and in particular the breastfeeding support was declared to be awful. This is where there was frequent mention of a lack of staff, the staff that were there being in a rush because of the number of women they were caring for, coming across as uncaring and uninterested. It also seemed that whilst midwives had the knowledge about breastfeeding and support, they didn't have the time to spend with women supporting them.

Another factor in whether or not women had a positive birth experience, appeared to be their expectations of how things would be. I have heard it said many times that for the woman with the explicit birth plan, strict dos and don'ts of what they want, is a straight to theatre kind of woman. Whilst this is said very tongue in cheek, there can be a bit of truth in that statement - in particular for the first time mother. If you've not experienced it before, then how can you truly know what you'll need? If you aren't expecting labour to be hard work, then it's unlikely that a choice of no pain relief is going to work out. If you are expecting to jump straight back to normal following a Caesarean section, then you will get a bit of a shock.

There are no gold medals given out for childbirth and whether or not you use pain relief, whether you "manage" without an epidural, whether or not you give birth vaginally or your baby takes the sun roof! Yet I have heard many women speaking of feeling like a failure because things didn't go to plan.

My advice to women would be to be as open minded as you can be about pain relief, and positions and what you might need. It's good to know roughly what to expect but don't get fixed on a plan.

My advice to myself and any other aspiring midwives would be to always listen to women; to always remember the value of time and try wherever possible to provide one to one care, to keep women informed, be honest with them and let them know what is happening. When you can't spend time with someone, explain why not but try to organise something so that they do get some time with someone who can help. I know this won't solve the problems of staff shortages but we can all do our best.

And finally I just want to say a huge thank you to all of you that contributed answers to my questions about your experiences. I think I have learnt far more than I have put into this post, and I value each and every reply.

Not one but three!

I made my way to the hospital last night feeling quite excited about the prospect of getting my first catch. I met with mentor and she asked where I was at with my training and I was quick to tell her that I'd made all my witnesses and was itching to get my first delivery. Funnily enough she also wanted to know about what else I'd done. 

We began the shift with a very quiet ward. We made sure the rooms were equipped, checked equipment, tidied up....found things to do. We soon had a couple come in from triage, whom we settled into a room and did the necessary checks that needed to be done, before encouraging the woman to mobilise. She was very comfortable so other than the regular checks on baby's heartbeat and how Mum was coping, we left them to it. When she was next checked, she'd not really progressed so my mentor broke her waters and her contractions soon became more intense so I began to spend longer with her to help her cope.  The next couple of  hours passed fairly quickly and my lady was having some early urges to push, so I spent a long time helping her to breathe through the pains instead. After a short while, it was apparent that she was really struggling not to push, so we encouraged her to use some pain relief, so she opted to use the entonox

At 5.00 my mentor returned from her break early, and told me to go to another room quickly. So I dashed off guessing that it meant a delivery was imminent. Sure enough, I entered the room and could already see the head beginning to appear. I quickly gloved up and put an apron on. Supported by the midwife, I caught my first ever delivery of a baby boy at 5.05.  I checked over the placenta with the midwife, cleaned myself up and then returned to my lady who following a dose a pethidine, was dozing between contractions. After a short while, she was still pushing with the contractions, so I popped out to see if my mentor had returned, as I knew she was due another examination shortly. At which point I was hurried into another delivery room, to quickly glove up and catch my second delivery. The lady was very controlled and very quickly delivered a baby girl at 5.25. Again I checked over the placenta with the midwife, and got cleaned up before returning to my lady. 

On my return to her, I felt that she was now really struggling to breathe through the pains and she just sounded like birth might be imminent. So I popped out to check on the whereabouts of my mentor, who'd got caught on the phone and reported what I'd observed. She returned to the room with me, ready to perform a vaginal examination to check how she was doing. At which point, we discovered there was no need to perform an examination, as we could see the head beginning to appear. Unlike the other two deliveries, this was a first baby so we could expect the second stage to take a bit longer. The lady was very well controlled and pushed really well, so that in actual fact, the baby was delivered within 10 minutes of us being able to see the head. So at 6.15 I had my third delivery, this time another baby boy. As with before, we checked over the placenta but this time I didn't need to rush off anywhere else. 

Of the three, the one that obviously meant the most, was the couple I'd been supporting throughout my shift. I got a much better experience of the progress, signs to watch out for and how to encourage and support women. When I finally sat down, I had a complete head rush and needed 5 minutes just to gather my thoughts a bit. It was a complete adrenaline rush and with three more nights to go...I am feeling slightly tired at the thought if they are to be like last night. However I loved it! I am hoping tonight that I get to have the journey of support through labour, as well as the delivery again. And perhaps slightly less running from room to room....and maybe even a break at some point.