Category: Caesarean section

Against the odds, Anaesthetics, Babies, Being a mum, Being busy as a midwife, Birth, Caesarean section, Communication, Compassion, Courage, culture in nhs, Digital, Hospital, Human kindness, Labour , birth, Labour and birth, leadership, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, NHS Systems and processes, Obstetrics, parents, Patient care, Postnatal care, Respect, Skin to skin contact, Student Midwives, Women's rights, zero separation

A midwifes role in the maternity theatre – support from managers

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Here it is my blog aimed at NHS managers and fundholders of maternity services – time to explain a few home truths. MORE support is required for midwives in the operating theatre from upper NHS management in order to facilitate and maintain SkinToSkin contact between mothers , fathers and babies .

A few reasons the midwife may have for leaving theatre include : –

  • To check the placenta
  • To take blood gases
  • To obtain documentation from a printer (which is not actually in the operating theatre)
  • To complete digital or written records
  • To register the birth

Let’s look at it another way – if an operating department practitioner said to a midwife “I just need to nip out for a few minutes can you step in for me for a few minutes and help the anaesthetist? ” how would a midwife feel ? How often does this happen ? Never !!

We must respect each another’s professional competencies and abilities and not take advantage of any given situation . The operating theatre is governed by health and safety due to the highly clinical nature of its environment . Midwives are selling themselves short by trying to manage their workload instead of questioning why they need more support .

We must deal with the root cause which is midwives leaving theatre to complete routine tasks (when they should be staying with women and babies)

The symptom is the fear of other staff in theatre of caring for the dyad , the woman’s fear at being unable to speak out that she’s scared of holding her baby during her operation or procedure .

The midwife has a professional responsibility for the mother and her newborn as set out in the NMC code of conduct and The NMC Standards for Competence for Registered Midwives

I’d also like to refer to these key parts of the NMC code which seem to address care of the dyad in theatre so well .

If you are a manager support your midwives by auditing the reasons why a midwife might leave a woman in theatre for any length of time and address that issue with the multidisciplinary operating theatre team – there will be solutions and the solutions will improve care , safety , women’s and families experience of care in the operating theatre and well as giving midwives immense job satisfaction, plus enabling team cohesiveness – what more could you ask for ?

I am challenging all line managers to go into the operating theatre and watch the midwife – how can you make it better for the midwife and therefore the dyad ?

Keep on keeping on

Thank you for reading my blog

Please leave your comments as I appreciate all feedback

Jenny ❤️

Babies, Being a mum, Being busy as a midwife, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Courage, culture in nhs, data colllection, Giving information, Helping others, homebirth, Hospital, Human kindness, Midwife, Midwifery, Motherhood, New parents, Newborn, NHS, Obstetrics, Post traumatic stress disorder, Psychology, PTSD, Respect, Skin to skin contact, Student Midwives, Working from the heart, zero separation

#BirthLeadership ©️ is Born

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Today is an exciting day for me . I have just registered a new hashtag that I hope will influence every woman and midwife . The hashtag is

#BirthLeadership ©️

As a midwife one of my aims is to display leadership towards women in order to support them through their labour and birth . I hope that this cascades onto future midwives so that they too can show leadership. This process may involve eye contact , holding hands , a hand on a shoulder , researching,debating decisions, reading information, challenging the system BUT together as a team to help make women feel like they are the leaders of their own births . Whatever the mode of birth it’s right that midwives let go and give the lead control to the woman . This can be through education and sharing views but first and foremost it must be about midwives listening to women’s hearts, voices, dreams and plans.

Midwives begin by championing women’s choices so that birth is given back to women .

Sheena Byrom OBE and Professor Soo Downe of UCLAN co-wrote an research article called “She sort of shines” Click here for PDF

in Box 1 as above the midwives interviewed were asked about the connection between leadership identifying commonalities between both .

The huge psychological impact of having no voice in a birth is well documented and can have long term physiological effects on a woman’s mental health . Studies on post birth PTSD (Post traumatic stress disorder) often highlight the lost voice of the woman and her fear of speaking out .

Birth leadership is created so that every midwife questions her own practice in order to ask herself “am I displaying birth leadership skills?” – in other words “what am I giving to this woman and her birth to relinquish my control and give her the lead in her own birth”

Let’s take for example coached pushing in the second stage of labour something which is neither evidence based practice or conducive to effective care – yet still it goes on. Click here for NICE guidance in 2nd stage of labour April 19

Some midwives FOLLOW this tradition and their fear of changing practice influences others negatively, preventing birth leadership in some NHS maternity units.

We must become champion challengers and this doesn’t mean loudly-it can be quite subtle and indeed this quiet way is less likely to disrupt a woman’s oxytocin flow – promoting both a sense of security and safety .

Let’s talk optimal cord clamping – and how Amanda Burleigh knew in her midwifery bones that immediate cord clamping wasn’t quite right – it didn’t sit well in her midwifery skin- @OptimalCordClamping showed Birth Leadership and started to challenge research and change practice which led to optimal cord clamping (OCC) being included on NICE guidance – Quality statement on OCC Amanda’s Birth Leadership is ongoing and she has inspired others to talk about OCC by inspiring them for example Hannah Tizard who is @BloodToBaby on Twitter . This is true practice change for women and babies . Here’s Amanda’s twitter feed .

The way you act in and out of work shows the person you really are . Your aim should always be to help others as much as you’d help yourself – keep that formula equal every minute in your midwifery career and you won’t go wrong .

Women need to know we care ❤️

Try and wear a new pair of glasses when you go into work – sit in a different chair for your lunch , ask colleagues “what are my good and bad habits?”, question your usual behaviour and remember why you became a midwife – to give the lead to women.

Birth leadership is about small steps or huge steps beginning with the next woman you are with as she gives birth .

If you have shown birth leadership of any kind use #BirthLeadership and tweet about it

Here are a few Birth Leadership examples

SkinToSkin in the operating theatre

Not weighing a baby until after it’s first feed

Leading a woman to change position in the second stage to avoid lithotomy

Helping a woman to birth and hold her stillborn baby and making the family a safe space ❤️

Helping a woman who has been constantly monitored on CTG to the bathroom for a walk and a wash

Being silent as a woman is in the second stage of labour

Supporting a woman compassionately through a difficult birth

Helping a woman to avoid unnecessary internal examinations

Being a baby’s advocate when the woman is having a GA Caesarean

Holding a woman’s hand in an emergency situation

Caring for a woman’s relatives as well as the woman herself

Here is an uplifting reply from @FWmaternity co-founder of MatExp and inspiring obstetrician who is supportive of Midwives and promotes her Trusts home birth team ❤️

NB please don’t think this about starting a campaign yourself although that would be great it’s about sharing the little things that signify BirthLeadership to inspire change – so please add yours on Twitter ❤️

Thank you for reading

Yours in Birth leadership love

Jenny ❤️

PS

Please add your comments to my blog – I welcome all feedback

❤️Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say, “We did it ourselves!”

Tao Te Ching – ancient Chinese quote about what being a midwife means ❤️

Antenatal education, Babies, Being a mum, being believed, Birth, Caesarean section, Charity, Communication, Compassion, Courage, culture in nhs, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, leadership, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, NHS Systems and processes, Obstetrics, Paediatrics, Postnatal care, Psychology, Respect, Student Midwives, Teaching, Women's health, Women's rights, Working from the heart, Young mothers, Young women

Midwives – Defenders of women’s rights @JennyTheM ©️ #IDM2019

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5.5.19 is international day of the Midwife and my blog is dedicated to all Midwives who have made a difference by defending a woman from any unnecessary intervention – be that anytime related to pregnancy 🤰🏾 antenatally , during any kind of birth or postnatally.

I’ve decided to share three stories which are true experiences written by midwives about defending women. One of the stories is mine but I won’t say which one .

As clinical midwives we are seen as equal members of the huge maternity wheel alongside women and their families, managers, obstetricians, future midwives , maternity support workers and many more – although in reality there is a hierarchy that many within our own discipline and other disciplines are striving to challenge and change .

The truth in plain sight is that just one member of the team is not engaged or equally involved (including the woman) then the intricate workings of the mechanism will be disrupted.

Women and families = get to know your midwife/midwives . Ask questions , be curious. Read books that are informative, recommended and that explain your bodies and your babies abilities with balance and clarity . Try the Positive Birth book by Milli Hill Click HERE to see on Amazon (founder of The Positive Birth Movement) .

Prepare yourself as much as you can. Don’t leave any stone of knowledge or information unturned . Join a positive birth group Click here to find out more . Be aware that midwives are defenders of women – talk to other women and find the midwife that helps you to believe in yourself . You’ll know when you’ve found her – don’t settle for second best. I believe women should rock the boat of maternity services like pregnancy pirates. Try reconnecting with midwife from a previous birth if you have other children – it’s evidence that continuity pf carer will reduce your chance of interventions so ask to see the same midwife at your appointments. Look at the birth statistics of your local units and choose wisely – ❤️ The Which birth guide is a good resource although might need updating Click HERE to view

Managers = be insightful of how staffing levels and skill mix will impact positively or negatively on birth outcomes – when you arrive to help us in our hour of need ask not what we can do but show us what you can do to improve our shift . Stay curious ❤️

Obstetricians = be mindful of the physiology of the female form and how your positive or negative behaviour will impact on the delicate balance of all hormones involved in playing out the birth process . Watch midwives working see them as equals . Stay curious ❤️.

Midwives = be aware of why you are a midwife. Embrace your role as not to

“do to”

but to

“be with”

to defend,to stand up for ,to support, to strengthen and to keep safe. Unite the team with your passion for all births❤️. Stay curious

Maternity support workers I am thankful for you all – you do support ❤️- your gratitude towards the midwives that make the toast and tea for the family and ensure rooms are left clean before transferring women from them . (we do ask other midwives to follow our suit) as we know you always have work to do within the scenes and behind them – running the operating theatre, birth-room turnaround time , restocking , clinical work, bringing the team together , being aware of all areas . The camaraderie and team work you display so strongly within your discipline is a benchmark for us all . Stay curious

❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️

Three stories of defending

Read on reader ….

Story one

The elective premature Caesarean birth – a courageous Midwife

All eyes upon me , the baby is only 34 weeks old . The mother’s instinct to hold her newborn is tangible I hear her breath . The paediatric team stand around the resuscitaire , prepped , ready, waiting and impatient. Something inside me tells me “give the baby to the mother , give the baby to the mother” After delayed cord clamping I cocoon the newborn in a warm towel without touching and within seconds I’m helping the mother with her first embrace. Time stands still. I monitor the baby closely but without words for colour , breathing , heart rate (with my stethoscope) tone and reaction , a saturation monitor on the baby’s right hand (pre-ductal) reassures me. All is good . I offer to take photos of mum dad and baby, mum and baby , baby’s hands touching mum , many photographic variations evolve in so little time . I look across at the paediatrician- she knows me, trusts me – she smiles at me and nods mouthing “it’s ok” . Five or more minutes have passed – mum knows it’s time . Dad carries his newborn to be seen by the team . Mum is crying not with sadness but with joy that hers was the first skin to touch her newborns , then her partners – this is how every new beginning of life should be – we Midwives must step aside but wait in the wings ready to prompt or assist- our silent presence is reassuring to the family ❤️

It was all worth the fear – afterwards I hug the paediatrician and say “thank you for trusting me ” the mother scrolls through her photos in disbelief that her only ever precious child started its journey against her skin – I am a defender ❤️

Story Two

The “Failed” Induction challenging a decision

“Can I help ?” I offered “Oh great” replied the ward Midwife “we are so busy!! Can you go with the consultant to see the woman who’s Induction didn’t work ?”

I’d been sent from labour ward to help on the antenatal area . The consultant was counselling an elderly primigravida ( over 45 years old) . The woman “Joy” (false name) was being told that two attempts at induction and due to her age that a caesarean would be for the best . I was sent to get the consent sheets . I’d just completed the AQUA shared decision making course and I was keen to put what I’d learnt into practice.

The time on the clock was 16.55 so bear that in mind .

What happened next was that the consent forms were handed to the woman after the risk of Caesarean was explained . The woman dutifully signed the consent forms and the consultant left the department. Something inside me told me this didn’t feel right . My instinct and experience made me go back to the woman and her partner. I asked them if they were okay with everything. In fact I went as far as saying “are you okay about your Caesarean birth?” They both voiced their concerns but felt they haven’t been given a choice. I wanted to discuss further so I went to the phone and rang the consultant to return . The phone call did not go well -the consultant was quite irked that I’d phoned told me to check the clock and to ring the consultant on call.

I rang the on call consultant who came and discussed further the choices the woman had with her and her partner . She opted for an attempt at labour following artificial rupture of her membranes which would all take place on the labour ward .

To cut a long story short the woman progressed to 5cm dilatation and remained there . She was very pleased with the fact that she’d experienced labour and been listened to . Her caesarean birth was a positive unhurried experience.

A few weeks later I came face to face with the first consultant one my day off – I’d come into work to attend a two hour study session . The consultant openly criticised me in front of a new senior registrar who I’d never met before – belittled springs to mind . “Thank you for overruling my decision to plan a Caesarean without labour” were the words. I stated clearly that the best way to clarify the situation was to determine how the woman felt – “are you invited to the naming ceremony of the baby ?” I asked “no” was the consultant’s curt reply – “well here’s my invite” I said (by coincidence I’d found it in the staff mail box that day) . The consultant went quiet and walked away . I am a defender ❤️

Story Three

Rebalancing the birth hormones

I met Nasrit about one hour into my shift in the morning. (name changed) . The community midwives has brought her in because her labour had slowed then stopped. Nasrit was having her third child, she lived with anxiety and panic attacks which were inherited from her childhood . My opinion was that her fear had disrupted her birth hormones – I discussed this with her – she held my hand tightly . I went to the midwives station and put Nasrit’s name on the board – as I did I could hear staff chipping in “does she need an ARM?” “Get the syntocinon running when the Reg arrives ” “is she actually labouring ?”

I pretended not to hear the comments . I was going to go back to Nasrit, Nasrit’s partner and Nasrit’s mother . My plan was to try and get Nasrit into a birthing state of mind . I wanted to make her at home. In giving her possession of her room I made her space – no lights , quiet , no interruptions and a haven for her birth . I keep a set of battery powered fairy lights in my locker and I’m trained to use aromatherapy. My key goals were to make sure I had everything in the room that Nasrit needed and nothing in the room that anyone else needed -there were going to be no interruptions. I used a blend of lavender and frankincense in hot water as a room infusion. I explained to Nasrit how aromatherapy would work. I then turned off all the lights and switched on the fairy lights . As an equal I explained to Nasrit and her family how relaxing can help oxytocin and that anxiety can hinder by producing cortisol and adrenaline . Nasrit was with me . I sat and held her hand (at her request ) we all waited without talking . I reiterated that there was no pressure . It took about 15 minutes for Nasrits heart rate to drop from 96 to 68 – she was breathing more calmly .

Over the next two hours Nasrit’s labour recommenced and soon she was holding her newborn skin to skin . I never left the room .

All was well

I am a defender ❤️

Summary

So the reason for my blog is for you to try and reflect on your own practice as a midwife and find those times when you were a defender. Look to see when you recognise fellow defenders through their words and actions . Try not to ask “does this feel right for the woman ? ” “is the woman’s face reflecting agreement or disagreement ”

Stay curious and keep defending

❤️We are defenders❤️

#IDM2019

Post script dedication I’m dedicating this blog to all midwives in hardship – whether physically, emotionally or financially. The Cavell Trust is a charity that helps nurses , health care assistants , maternity support workers and midwives Click HERE for more information

Thank you for reading my blog .

Yours in midwifery love

JennyTheM ❤️

Stay curious

and like Professor Lesley Page (@Humanisingbirth on Twitter) be the leader of the dance ❤️❤️

Anaesthetics, Antenatal education, Babies, Being a mum, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Courage, culture in nhs, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Human rights, Kindness, Labour , birth, Labour and birth, leadership, Learning, Midwife, Midwifery, Midwifery and birth, Motherhood, Newborn, Newborn attachment, NHS, NHS Systems and processes, Obstetrics, Postnatal care, Skin to skin contact, Student Midwives, Women's health, Women's rights, zero separation

The birth of my son

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25 years ago today I gave birth by Caesarean to my second child . A boisterous boy to compliment my daughter who had been waiting to become a big sister for over 5 years .

I was so excited about going into labour as I was now a midwife – I “knew” what to do – I felt positive and excited .

A few weeks before my due date I suspected my baby was breech and told the consultant “Oh Jenny why are you doing self palpation ? “It’s obviously cephalic” he said (I didn’t know I was going to have a boy ) – “stop worrying!!”

Off I went on my merry way .

Fast forward to my term appointment with my midwife (I had started to have a few niggles but I was determined not to rush into hospital and previous complications meant a home-birth wasn’t an option) . My midwife confirmed my concerns – the baby is breech and there’s nothing in the pelvis at all . I was sent to the hospital – I felt annoyed with myself .

About 5 hours later I was in theatre having a spinal in preparation for a Caesarean. In those days the false evidence of the vaginal breech trial was forced upon many women – I was frightened into having a Caesarean – I truly felt robbed .

I took it all on the chin and decided that it as a midwife would be an asset to have experience of normal birth and Caesarean. This personal experience of mine would help women to know that I’d understand and support them through any birth .

At my Caesarean my son was born – I saw him for less than a few seconds and he was whisked out of theatre into an ante room . There he was wiped down, rubbed, touched and handled by midwives. Then my son was measured,weighed, given vitamin k dressed and wrapped up . I didn’t hold him for 4 hours and I wish I’d been able to.

Not having skin to skin contact in the Operating theatre hasn’t affected the relationship I have with my son . I did however long to hold him whilst I was in theatre and kept asking where he was and when I could see him.

Not having skin to skin contact has made me determined to educate women and those who attend birth in the operating theatre as to why skin to skin it’s so utterly important- it’s a physiological norm for human mammals .

Each time I’m with a woman in the operating theatre I don’t feel angry or upset about my experiences- I just feel very thankful and grateful that times are changing and that skin to skin is becoming normal in the theatre environment.

Skin to skin was never mentioned to me at all for my son’s birth – God forbid a woman would want to hold her baby whilst being operated on in the 1990s !!

Well thank goodness times have changed and that there are lots of brilliant midwives, theatre nurses , obstetricians, anaesthetists and operating department practitioners who know why skin to skin matters . In helping families they are changing the system. They realise that birth in the Operating theatre isn’t about “their theatre” functioning in the same way it always had done but about making the Operating theatre a “family space” .

Once I got to the ward a dear colleague of mine (who has since retired) came to see me and asked me if I’d had skin to skin contact. I hadn’t even fed my son yet!! – luckily my son was a sturdy 8 pounder . My lovely friend passed my son to me so that I could take his sleep suit off , explore his skin , check his fingers and toes , gaze into his face and start our journey as mother and son . He was soon breastfeeding and I felt relieved that my friend had supported me .

If you are wondering whether I’d be such a protagonist for skin to skin if my second birth had been different? I know I would be !! The infamous Dr Nils Bergman set off my interest in why skin to skin matters for all newborns and he instilled in me a duty to spread the word.

I am really proud to have helped many women to overcome their doubts and fears about skin to skin in the operating theatre and I hope I continue this journey with many more families.

This blog is dedicated to my son and daughter who have made me the mother who I am .

Happy birthday son ❤️.

Thank you all for reading.

With love

❤️Jenny ❤️

Babies, Being a mum, Birth, Breastfeeding, Caesarean section, Communication, Compassion, Hospital, Human kindness, Human rights, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, Newborn attachment, NHS, Obstetrics, Skin to skin contact, Women's rights, zero separation

SkinToSkin poem © by Jenny Clarke

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it really doesn’t matter where you are

Home , hospital , Operating theatre, birth-pool or sat on a star 🌟

The ultimate way for a baby’s life to begin

Is right next to her mother in SkinToSkin

Your baby doesn’t care what she weighs

Read and digest the ATAIN study – we adore what that says

SkinToSkin contact for babies 37 weeks or more

can reduce unplanned admissions to special care- that’s the score

It helps stop separation of you and your baby

That’s a fact – no ifs,buts or maybe

Prolonged SkinToSkin makes you more of a team

So that baby can understand you (and vice versa) – see what we mean ?

SkinToSkin is no fad, craze or latest trend

SkinToSkin makes mother’s better mothers that’s why @JennyTheM is here to bend

your ears soon in Breastfeeding Week.

I have read all the research by the SkinToSkin geeks

I am giving you the evidence and it’s right up your street

So make plans , prepare for SkinToSkin don’t leave it to chance

When your baby gets SkinToSkin she’ll move about – a newborn birth dance

SkinToSkin sets off behaviour ,keeps baby’s calm

Us humans are mammals -made to keep our young warm

So at birth just consider how your baby will feel

SkinToSkin will tell her –

YOU ARE the real deal ❤️

© @JennyTheM 27.3.19

My next blog will be about the need for correct positioning for mother and baby (or other mother and baby or father and baby ) in order for SkinToSkin to reach its full potential and benefits ❤️

Antenatal education, Being a mum, Birth, Caesarean section, Compassion, Courage, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Human rights, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, NHS, Obstetrics, Respect, Skin to skin contact, Student Midwives, Surgery, Women's health, Women's rights, Working from the heart

Fear of Birth – A Poem

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I didn’t want a labour -everyone in my family knew

I did want a baby though

-my desperate feeling was not new.

I’d always been nervous,fainted at the sight of blood

told myself time and again that at birthing I’d be no good

My husband eventually won me round

We started trying for a baby but my mind couldn’t rest

So many ifs and buts and a maybe

we were pleased when we found out the positive test,

Inside my body though I felt so stressed

I had a tightness in my chest

I almost wanted to shout & shriek (no one seemed to listen)

I tried to talk about Caesarean birth with health professionals through the weeks

-somehow they didn’t hear me -I felt soft , so ridiculous so weak.

I couldn’t express my feelings, my fear of giving birth

I felt anxiety would pass to my baby -I had no sense of worth .

I went into labour I was scared and full of fear

my husband and my mother were with me it helped me to have them near

I failed to express myself to the doctors that I just couldn’t do it

But it was as if my words couldn’t come out- I truly almost blew it .

What happened next was down to the perception of my midwife

She saw the turmoil I was in recognised my inner strife

She stood side by side with me , told the Drs what I’d said

She was my birthing advocate – my saviour through the dread

A plan was made they’d finally noted every word I’d spoken

I was going to have a Caesarean section it was as if I had awoken

Don’t presume my fear had simply run away

I was worried ,scared and still not quite sure what to say

During the birth I could not look or speak or move

But when I held my baby skin to skin I was overwhelmed with love

My child was born and passed to me – I had achieved so much

And to the midwife that heard me through the tears – THANK YOU – for your listening touch

You really made a difference to me and my family

I don’t know how I’d have coped if you hadn’t stood side by side with me

@JennyTheM 16.5.18

Dedicated to Yana Richens OBE @Fearofbirth on Twitter for raising the profile of women who have fear of birth and for teaching Midwives and future Midwives strategies to help women ❤️ thank you ❤️

Babies, Being a mum, Birth, Caesarean section, Communication, Compassion, Courage, Helping others, Hospital, Human kindness, Intra-operative care, Kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, Newborn attachment, NHS Systems and processes, Obstetrics, Student Midwives, Women's health, Women's rights, Working from the heart

Making a sacred space for birth

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This blog is inspired by the women I have cared for as a Midwife and also the wonderful Spirituality and Childbirth book book by & Dr Susan Crowther and Dr Jenny Hall . The women I have met and cared for in my midwifery career have helped me to invent new ways of working for and with them.This experience has shown me that in order to achieve a special birth experience we must be connected with the woman . The value of approaching each woman with a different perspective but the same professional compassionate values regardless of their mode of birth is the core of individualised care .

It’s taken me all my midwifery career to reach this point and I am still evolving.

Making a sacred space for women and birth is something that we should all consider as midwives. How many times do we enter a room of birth to find the light shining brightly the window blinds up, the CTG machine on full volume and the sounds of the hospital permeating into the room ? Who has the right to enter the birth room ? Perhaps now is the time to talk about consent and to ask women whether they want people to come in and out of their room for non-essential reasons such as trying to find equipment or the medicine cupboard keys . Do your labour wards and your birth centre rooms have a curtain after the door to maintain the dignity and privacy of the woman and her partner and to keep the sacred space? Are the room, it’s people and contents treated as “our” (Midwives and obstetricians ) space or as the woman’s (family , partner , newborn) space. Do we GIVE the space to the woman she enters the room? Saying “this is your room , this is your space I am your guest” or is it seen that we take control of the area ? What exactly is the solution? . I think one of the answers is to start by questioning ourselves as to how we are behaving. There are guidelines to help us give evidence based care and evidence shows that dark quiet rooms , aromatherapy , touch and the continuous presence of a midwife are all beneficial for women in labour as they give birth . How do we transfer this to a birth in the operating theatre or an area where women with a higher chance of intervention are cared for ?

Do we need a new guideline that encompasses making a sacred space ? I think so .

We must celebrate that midwifery care is still an essential core aspect of birth in the U.K. and share our stories . To summarise the work of Dr Trish Greenhalgh – each person we care for shows us new evidence and this can be individual evidence – it doesn’t need to be large scale. Therefore if your compassionate care works then that’s your evidence .

My tips for making a sacred space are

  • Explain to the woman why a newborn appreciates a peaceful place to arrive in
  • Ask about aromatherapy try to stick with no more than three essential oils as using more can dilute the effect
  • Look at the lighting in birth rooms – can the lights be dimmed – find a lamp to give you some light for record keeping
  • Take all that’s required into the room and make yourself an area that does not intrude into the woman’s space but that also increases your time in the room
  • If the Drs come into the room and require extra lighting turn it down after that requirement ends and try to use local lighting instead of general lighting
  • Use a drape in theatre to create a skin to skin tent where the new family can bond and take photos and don’t leave them to do your notes – do that later . Keep a check on the mums and baby’s condition regularly.
  • Use massage to help increase the woman’s own oxytocin levels and darkness will also enhance the melatonin / oxytocin effect .
  • Stay calm and talk quietly – try not to disrupt the woman’s hormones which are affected by noise .
  • A sacred space means comfort , calm , love and kindness must be tangible within that area – it’s not about the space as much as the atmosphere- the way you help a woman to achieve this will have a long lasting positive effect not only on her self value but also impact you in your own practice in a wonderful way .

Please think carefully wether you are a hormone disruptor or a hormone enabler .

Be a true Midwife .

This blog is not to tell you how to be but to provoke thought on our practice and try to help you and others to see how we can effect a positive change for women in their birth settings

Thank you for reading

Yours in midwifery love 💕

Jenny ❤️

Against the odds, Babies, Being a mum, Being busy as a midwife, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS Systems and processes, Obstetrics, Postnatal care, Respect, Skin to skin contact, Student Midwives, Women's health, Women's rights, Working from the heart, Young mothers, Young women

Postnatal transfer to the ward from labour ward – my thoughts

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A DM (Direct Message) on Twitter is a message you receive from someone that no one else can see – apart from the people included in the message.

In the past four weeks I have received 7 DMs from a mixture of midwives , future midwives and women all with the same subject matter . This subject is mainly about ‘who decides when a woman is transferred from the room she gave birth in to the postnatal ward’ This seems to be a hot topic at the moment as the variation in time from birth to transfer is huge – especially when comparing Caesarean birth transfers to other birth transfers (and it might surprise you to know that the variation in birth to transfer time to the ward for women who have Caesarean birth is also vast – some units care for these women on the labour ward until their spinal has worn off , some units transfer to ward within a short time in recovery which leads me to question that support with breastfeeding must be patchy).

Just the other week at Salford University Midwifery Society Conference ‘Transforming Birth’ click HERE for a summary of the day – I asked a question to the audience “are you, as future midwives pressured to move women to the postnatal ward (after they have birthed their babies) faster than the women themselves would like or you as a future autonomous practitioner would like ?” The result was that over 80% said YES.

Do we as Midwives consider our own autonomy enough when we are working ? In order to give the woman a sense of feeling cared for and nurtured individualised, compassionate, holistic midwifery is paramount . Each woman is different- some may prefer a rapid transfer , others may not . Some women may need extra support to establish breastfeeding or be debriefed post birth or some women may want to rest in a quiet place with minimal noise before they are moved to the ward . If a birth takes place in a birth centre which doesn’t focus on time , women will stay in the same room post birth until their discharge home.

In the NHS patient care sadly revolves around the concept of time . If a patient is not seen , admitted or discharged within a four hour time frame (see photo below ) it is considered a “breach”

Certain procedures have a standard time frame in which so many can be done – this is how operating theatre lists are generated and how the NHS deals with waiting lists .

However birth is and must be a positive experience – even though it has coding costs and some births are planned to the day -we must give women more than they expect – stand up for them , be their advocates. Challenging the system is one of the ways we can make change happen – if we all accept each day “this is the way we do this” we cannot be developing our roles or our practice to improve woman centred care . I’m not saying it’s easy but I want you to imagine what care you would want for your sisters and your daughters ? Then give the women THIS care – I am in the NHS as I nursed my own mother until her death at home – I see the connection between care at birth and care at death . I have been a nurse to the dying and that experience has impacted on the care I give to women in a most human way .

Whatever care you give , whether you transfer a woman in your fastest time or not is all rather irrelevant when you focus on the bigger picture – YOU are responsible for the care you provide , or you don’t provide -if you tell a student to do something that is YOUR responsibility and I suggest referring to this NMC publication which I look at each day The NMC CODE . If advice or suggestions are not kind , caring and have a direct clash with your duty of care , if a more senior Midwife tells you to do something this should be documented in the notes and be evidence based, kind and resonate with your trust guidelines plus the NMC code.

Sometimes we are stretched short staffed , rushed and under pressure but at no point should this be the woman’s problem.

So the next time you are preparing a woman for transfer to a ward just think

  • Have I given her & her partner enough time alone with their newborn
  • Have I helped initiate feeding
  • Am I rushing her ?
  • Do I feel under pressure ?

Then if necessary give her some more time – and when you arrive on the ward give continuity of care to the woman and her newborn by transferring in SkinToSkin contact , admitting them both to the ward environment yourself , taking and recording observations , checking the woman’s pad and fundus ,getting the woman a drink and this will also help your colleagues on the ward immensely.

❤️Be a holistic professional caring Midwife ❤️

Thank you to the student of Salford University and those who DM’d me on Twitter – you inspired this blog

Thank you for reading

Yours in midwifery love

JennyTheM

❤️

Against the odds, Anaesthetics, Antenatal education, Babies, Being a mum, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Courage, Giving information, Helping others, Hospital, Human kindness, Human rights, Intra-operative care, Kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, Newborn attachment, NHS, NHS Systems and processes, Obstetrics, Patient care, Postnatal care, Respect, Skin to skin contact, Student Midwives, Teaching, Women's health, Women's rights, Young women

Birth imprinting – SkinToSkin contact

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As a child is born to a mother there are emotional , hormonal, physical and psychological needs that are satisfied when SkinToSkin contact occurs and these will give both short and long term health benefits to mother and child .

A mother should be the first person to touch her newborn and that is one of the reasons that midwives should wear gloves. The mother’s skin will imprint the newborn with her smell, touch and love – the newborns face, smell and skin will imprint onto the mother and these are processes which are golden moments not to be missed .

If a mother is feeling unwell or anaesthetised the midwife should hold the newborn next to the mother’s skin for her , taking photographs with the mother’s phone or camera will enable the first sight of the baby to be saved and also surpass consent issues around photographs- the parents can then choose what they show to others and what they keep .

A Midwife is the woman’s and the newborn’s advocate and it’s crucial that the Midwife finds a way to involve the second parent in skin to skin contact somehow after the mother has held her newborn for a sufficient time to enable the first breastfeed .

If a woman wants to breastfeed once this has the benefit of giving colostrum as a gut protector and immuniser- colostrum contains immunoglobulin.

In cases of premature birth courage , knowledge, dexterity and skill are needed to enable skin to skin to take place . The value of collaboration (as discussed by @CharleneSTMW at a recent MatExp event at Warwick Hospitals cannot be understated – all members of the team must be aware of the benefits of SkinToSkin contact at Caesarean or instrumental birth .

We must all sing from the same sheet and share the same values so that everyone agrees that skin to skin with mother takes place before any other intervention .

Skin to skin is not an intervention it is something as natural as putting your key into your front door without thinking about it . However it seems that women and newborns are in a postcode lottery – where you live and which hospital you attend for your birth can determine and influence your chance of skin to skin .

I receive many requests from midwives from the NHS and across the world asking me to help them overcome barriers to facilitating skin to skin contact within their workplaces especially in the operating theatre . Some are stopped by anaesthetists, obstetricians , some ridiculed as strange by their colleagues and told “it’s not happening here” . We must remember that nothing is final and show the evidence which is growing by the day that skin to skin contact is not something that can be measured , it’s a primitive response which comes as second nature to a new mother – if that mother is out of her comfort zone she won’t have the strength or courage to question why – that’s OUR JOB !

Many ago I recall being told by some midwives “it won’t be happening – it’s too complicated ” and now I smile as I see midwives like @jenistevenssts in Australia studying skin to skin in the operating theatre for her PhD thesis, NICE GUIDANCE CG190 even includes SkinToSkin thanks to midwives like @drtraceyc who campaigned for its involvement and birth activist @millihill writing about it in her book (picture below)

The priceless value SkinToSkin is spreading across the world and if it’s not happening I’d like YOU to question why

This blog is dedicated to my mum Dorothy Guiney 22.2.1925 – 22.9.1978 ❤️

Anaesthetics, Antenatal education, Birth, Breastfeeding, Caesarean section, Change management, Communication, Compassion, Helping others, Hospital, Human kindness, Human rights, Intra-operative care, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, NHS, Nursing, Obstetrics, Paediatrics, Patient care, Respect, Skin to skin contact

The operating theatre tea party – read on to find out more 

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This week I was lucky enough to be in the multi-disciplinary team involved in the care of women pre peri and post – Caesarean section . 

Lucky you say ? Aren’t midwives supposed to only be focused on PHYSIOLOGICAL  birth ? well yes that’s one of our roles but we also care for women in the antenatal period – we run triage clinics with the fab support of a skilled maternity support worker – running tests on women then contacting the Dr for advice with the results – pure team work . We also care for women in labour who have complex medical needs , complex mental health issues and we work WITH the obstetric team to find the best plan of care – we do this together with the woman’s input . I am proud of everyone I work with – they give me hope . We also work on birth centres and attend pool births . We are community midwives we attend home births , we support women who have safeguarding issues , women who live under the threat of Domestic violence and women who have disabilities. We manage wards , units , we are heads of midwifery , we are ward midwives , labour ward midwives , specialist midwives  and we are mothers , fathers ,single women/men  , gay women/men  , straight women/men  , married men/women , we are spinsters / bachelors but most of all we are HUMAN BEINGS .  

Each birth I see means a lot to me as a woman, a midwife and a human . I don’t judge a woman because she has a more complex or simple birth than the births I had – I’m in MIDWIFERY because I want women to feel positive about their birth experience and EVEN after this weeks news I am still determined to try my best to promote physiology in all birth settings . 

Anyway back to the operating theatre . 

The team in the operating theatre where I work are so together with the families they meet . They all know the importance of #SkinToSkin contact and how utterly important it is for the woman involved to hold her newborn asap . So the ODP makes sure that the woman tucks one sleeve of her theatre gown under her arm , places the ECG electrodes on the woman’s back and adds a mini – extension to the top of the theatre table so as to give the woman a greater sense of space to hold her newborn . The scrub nurse prepares a sterile space on the cot for the obstetrician to place the baby onto AFTER delayed cord clamping has taken place . The baby is dried on the theatre table and then placed on a sterile sheet on a cot with wheels – the Midwife assesses the baby’s condition at the side of the parents – so they feel involved and the baby is not weighed – we aim for skin to skin contact prior to 5 minutes of age – unless there are concerns with the baby’s health – both parents see the baby immediately and one of them cuts the cord . The other parent is then helped with placing the newborn on the mothers upper chest safely in a prone position and the midwife STAYS next to the woman and her newborn supporting them so that skin to skin can continue for as long as possible , I have piloted this and women who are supported hold their babies for longer – so I leave my records until we go into recovery area . Photographs are encouraged (as many as the family want to take) and also music . This week we asked a woman which music she’d like – we don’t yet have a Bluetooth speaker in  theatre just yet (watch this space)  so I put my phone on as Coldplay was requested . The consultant anaesthetist (Dr Richard Cross ) left the senior registrar in anaesthetics in charge whilst he was away for two minutes . When he returned he was holding a metal NHS supply teapot – we all looked puzzled 😕 . Then he carefully placed my phone into the empty teapot – this acted like a mini speaker and it was just the right volume for the family – but not too loud to disturb the surgeons and the safety in the theatre . 

What I’m trying to say is that this kind gesture was all for the family – especially the woman – we were making memories for her – she’ll always remember that she held her newborn , whilst listening to Coldplay from a teapot – what could be better than that 

Once safely in recovery (transfer to recovery area takes place with skin to skin ongoing ) we encourage birthcrawl by the newborn and praise the infants behaviour as this helps with the maternal connection . The woman is offered water quite soon after (unless she has had a general anaesthetic- in which case we wait until she is safe to tolerate water ) and then a cup of tea ( two half cups so none has the potential to spill onto the newborn ) and some toast which helps with enhanced recovery – we try to take our time with being in recovery as the woman needs more time to bond with her child due to restrictions on movement due to theatre drapes & position . 

Thank you Richard Cross and all the team in theatre for your kindness , laughter , compassion and care 
I hope you enjoyed reading this latest blog 

P.S what I didn’t mention was that there was a language barrier , but kindness , compassion and communication still took place – and the music connected us all ❤️

Happy Saturday -with love  Jenny xx