Category: Change management

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Does the NHS need to rethink the way health professionals are made to approach their work ?

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It’s been a while since my last blog. This post is to help those in the NHS whatever their role or position to consider that positive individuality makes for a better NHS . In embracing positive individuality all care will improve , status quo will be rocked and the NHS will develop doing things differently within your workplace.

Predictive text steps in as you type on your phone . Wikipedia have a link about predictive text CLICK HERE and surprisingly personal data in the way we write and assemble sentences means that each device is personalised to the user . This has set my brain off thinking that actually we are all diffferent generally. Sadly NHS management would like us to work in the same way a sort of “predictive” way of working . However humans are unpredictable that’s just how we are made. Are personalities and individualism therefore disregarded ? Let’s take for example shift work – some Trusts have a better family and also life friendly approach to staff . The Kings trust have researched that staff who are cared for and well-engaged make for a more successful NHS – that in turn has a positive effect on the people being cared for .

Midwifery cannot be like predictive text eg this is the way we do it , this is the length of time you need to help a woman, new offspring & partner postnatally before transfer to the ward and so on .

It’s time for managers to realise that each woman is as individual as the midwife who is “WITH” her . An acceptance that “this is the way that Midwife B works . Each midwife’s Way of working is in fact data. The midwife who spends longer explaining to the family who are going home (eg explaining symptoms of wellness , symptoms of illness , to contact the labour ward not the emergency department for advice , self care , and current evidence) is perceived as slower but in fact this is the midwife who probably is more thorough and probably a perfectionist who raises awareness in the women and families she meets .

If you ever get told you’re too slow – don’t take it as an insult take it as a compliment

You are dedicated , perceptive, compassionate, thorough and you promote self awareness to women and families

Keep on keeping on

Sending love to all the THOROUGH midwives nurses and other health care professionals out there in the NHS

Love , as always

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 ❤️

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 ❤️

Being busy as a midwife, Change management, Communication, Compassion, Courage, Discharge planning, Giving information, Helping others, Hospital, Labour and birth, Learning, Midwife, Midwifery, Midwifery and birth, NHS, NHS Systems and processes, Obstetrics, Postnatal care, sepsis, Women's health, Working from the heart

Here is your role as a NHS Midwife …… my suggestions

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Here is your role as a Midwife in the NHS

  1. learn about the guidelines and policies at your place of work .
  2. Complete your mandatory training come hell or high water despite not being given allocated time to do so
  3. Get up in the morning / the evening travel to work be on time , report for duty .
  4. Push yourself each day to be a little better than you were the day before
  5. When you are upset about something try and soldier on because everyone else is in the same situation
  6. Support new midwives and future midwives – be a role model as everyone takes note of the way you behave at work (don’t for a minute think that they don’t !)
  7. Practice 1-5 each day now add in caring  for women families ,getting along with your colleagues , getting a break everyday and leaving your shift on time

Stick to …….

Wait a minute Wait a minute.   REWIND REWIND REWIND ……

  1. Get on Twitter and join the community of midwives there sharing evidence based practice
  2. Immerse yourself in the computer system that will give you stats for your own practice (as well as others ) and look at how to improve them.
  3. Practice a daily ritual that is kind to you – respect yourself and your body clock get fresh air and sunlight each day pre or post shift Watch this programme “The body clock- what makes us tick?” on the relevance light (measured in LUX) has on the body clock and circadian rhythm .
  4. When you are happy and /or upset about something try and reflect on it through writing or recordings and seek advice from your occupational Health dept. Team up with another midwife from a different NHS trust and see yourselves as support buddies , reflect together on what helps you at work and learn new positive ways of staying focused and compassionate in your midwifery work
  5. Be professional in all you do through the your words / deeds / behaviour towards others including the way you communicate on your break – integrity is a huge part of being a Midwife . The words you speak in the office / break room and out of work are like a fragrance upon you when you are caring / mentoring and teaching.
  6. Having a break is set into statutory employment law – it ain’t no privilege – so plan your own break and get away from your work environment eat your food in a quiet place, do three minutes of mindfulness – your break time belongs to YOU – if you can’t take the full amount at once try breaking into bite sized amounts so you can eat / / rest / reflect but perhaps on three short breaks instead of one long one -also support your colleagues to do the same
  7. If you are a manager/head of midwifery consider how you get your lunch and try to be a role model – go and eat with the staff you manage – you might find out more through this than leading meetings
  8. If you hear a group talking about another colleague in a derogatory manner then challenge them why are they discussing someone who isn’t there to defend themself, then ask them to stop – if you choose to ignore this kind of behaviour you are condoning it
  • Always remember you are not at work to socialise but to put the women and families at the heart of what you do . If you find yourself questioning a colleagues work style – ask yourself this “is that colleague putting the woman first ? “
  • You’ll probably find the answer for the style of work is because the answer is YES!! So if you have a colleague who may seems to take a little longer with women or isn’t seen in the office much try and shadow them – sometimes taking some extra time can be more cost effective – a long chat pre discharge can arm women with knowledge about how to recognise SEPSIS , help her to recognise when her baby is feeding well or not and also to pickup POSTNATAL DEPRESSION earlier .
  • These are just my thoughts and it’s my first blog for ages so I hope you enjoy it
  • Be kind ❤️
  • Yours in midwifery love
  • Jenny ❤️©️2018
    • 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 

    Anaesthetics, Antenatal education, Anxiety, Being busy as a midwife, Birth, Change management, Communication, Compassion, Fear of Birth, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, MatExp, Midwife, Midwifery, Midwifery and birth, Newborn, NHS, NHS Systems and processes, Obstetrics, Paediatrics, Psychology, PTSD, Respect, Women's health, Women's rights, Young mothers, Young women

    Loss of control – a reason for fear of birth ? 

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    When any of us are admitted to hospital we lose control . We are unable to get a hot drink when we want one , eat what we want when we want to ,take simple pain relief , go to the toilet , sleep as well as we would at home , get up in the night or stay in bed longer . We are also unable to control what we hear , what we see . We lose our safe place of home and being surrounded by friends and family – it feels lonely and alien to us . This doesn’t mean that we are not able to adapt to new situations it’s just that more than a few things change and this throws a curveball towards us .  The fear we feel is because we feel we are handing ourselves and our bodies , our routines and home comforts over to others, they are dismissed  – this has quite a destabilising effect on our psyche . 

    A key part of NICE CG190 guidelines for care in labour encourages midwives to set the scene for women. The section I am going to focus on is COMMUNICATION – which is part of 1.2 Care throughout labour (click on the following numbers to be taken to the site)  CG190 

    I have copied and pasted the exact words and written the key words in CAPITALS below to help highlight their impact – does it make you think about them differently ? 

    COMMUNICATION 

    1.2.1 Treat ALL women in labour with RESPECT . Ensure that the woman is in CONTROL of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To FACILITATE this, ESTABLISH a RAPPORT with the woman, ASK her about her WANTS  and EXPECTATIONS for labour, and be AWARE of the importance of TONE and DEMEANOUR , and of the ACTUAL WORDS used. Use this information to SUPPORT and GUIDE her through her labour.

    1.2.2 To ESTABLISH communication with the woman:

    GREET     the woman with a SMILE and a personal WELCOME, establish her LANGUAGE NEEDS , INTRODUCE yourself   “#HelloMyNameIs”

    explain your ROLE in her CARE .
    Maintain a CALM and CONFIDENT approach so that your demeanour REASSURES the woman that all is going well.

    KNOCK     and WAIT before entering the WOMAN’S ROOM , respecting it as her PERSONAL SPACE , and ask others to do the same.

    ASK     how the woman is FEELING and whether there is anything in particular she is WORRIED about.
    If the woman has a written BIRTH PLAN , READ  and DISCUSS it with her.

    ASSESS     the woman’s KNOWLEDGE of strategies for coping with pain –PROVIDE  BALANCED INFORMATION to find out which available approaches are ACCEPTABLE to her.

    ENCOURAGE the woman to ADAPT to the environment to meet her INDIVIDUAL needs.
    Ask her PERMISSION before all PROCEDURES and OBSERVATIONS, FOCUSING  on the WOMAN  rather than the TECHNOLOGY or the DOCUMENTATION .

    SHOW the woman and her birth companion(s) how to summon HELP and REASSURE her that she may do so WHENEVER  and as OFTEN  as SHE NEEDS to. When LEAVING  the ROOM, LET her know when you WILL return.

    INVOLVE     the woman in any HANDOVER OF CARE  to another professional, EITHER when ADDITIONAL EXPERTISE has been brought in or at THE END OF THE SHIFT. 

    Every person who cares for (no matter how short a time ) a woman in labour should follow this guidance and I feel there should be posters up on maternity units in all languages which emphasise that this will happen . 

    There are many barriers to communication and one that most midwives, student midwives , maternity health care assistants , obstetricians and anaesthetists agree on is that time, pressure and NHS systems restricts our practice. I want to have laminated cards that go with the analgesia cards to explain why kindness and compassion will also help ease women’s pain . Fear is a huge factor in the perception of pain and if we try to reduce fear we might help reduce not only  pain but also anxiety and then by this we will gain trust and build on positive care. 

    As the  midwifery workforce we must start to say to ourselves “how would I feel ? ” another question which is used on the Nye Bevan leadership module is this …. 

    Lets keep sharing our ideas and thoughts and if you have any more relating to CG190 – tweet using #CG190 or why not write a blog or design a poster ? 
    Thank you for reading and please leave comments , I always value them and they help me to reflect and grow . 


    Yours in midwifery love 

    Jenny ❤️

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

    The Caesarean experience 

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    How good is the approach to women who have a caesarean to birth their babies ? Do all NHS trusts routinely give the same care to each woman and newborn or is it tailored to each individual ? 

    I am passionate that the caesarean procedure is also a positive uplifting experience for the woman her partner and their newborn . 

    I get upset when I hear stories from different midwives at various NHS Trusts that skin to skin contact at Caesarean section isn’t routine or perhaps not discussed antenatally . From today I’m championing that skin to skin contact should be a priority for ALL WOMEN AND BABIES in the operating theatre and I’m doing this for several groups of women including those who

    1. Were totally unaware that  skin to skin contact at caesarean was possible . 

    2. Hear stories of women who held their baby skin to skin perioperatively when own their babies are older and they missed out on it which leaves them feeling robbed and upset. 

    3. See photographs of babies in skin to skin contact during caesarean and they didn’t know they could take photographs 

    4. Realised that skin to skin is possible but they weren’t given the choice 

    5. Feel sad that the baby’s other parent wasn’t encouraged to hold their baby skin to skin during the caesarean operation . 

    And this blog post is also for any woman who has an assisted birth in an operating theatre – I’m going to help you challenge NHS systems and change the birth discrimination between normal birth and birth in theatre . 

    Why am I calling this BIRTH DISCRIMINATION ? 

    In my opinion every woman who gives birth should have the chance to hold her newborn in skin to skin contact even if only for a few minutes perhaps because the newborn requires transfer to neonatal unit or the woman feels unwell peri-operatively . 

    Women who have a normal vaginal birth are more likely to hold their newborn for longer and separation from their newborns during the ‘golden skin to skin  hour’ will be less likely to happen. However, if a child is born in the operating theatre separation will occur within half an hour because of risk assessments meaning that the baby is moved as well as that within some NHS Trusts phones or cameras are not allowed in theatre and here are my thoughts on this matter which is close to my heart . 
    We can no longer ignore the birth discrimination that exists between normal birth – where the woman has prolonged uninterrupted skin to skin contact – and assisted birth . It’s the role of everyone who is involved with birth in the operating theatre to work together to reduce and / or eliminate this birth discrimination.  I’m talking about midwives , anaesthetists , paediatricians , obstetricians , neonatal nurses , ODPs , maternity support workers coming together to form multi-disciplinary teams to plan how skin to skin contact length and opportunity can me maximised and separation minimised . 

    We are all aware that skin to skin contact is beneficial in numerous evidence based ways (just go onto google scholar and search “skin to skin contact at birth”  to both mother and baby. It is NOW time to take action and assess each woman and baby individually instead of adhering to a ‘one size fits all’ approach . Of course there are women who may have to have a general anaesthetic – so consider this from the baby’s point of view – and work out a way that the other parent might be able to provide skin to skin for the newborn . 

    We are in 2017 and now is the time to make change happen – talk about this to your MSLCs , the labour ward forum meetings , MDT meetings and be pro-active – together we can all make a difference 

    Thank you for reading – jenny ❤️

    To be continued ….. 

    Against the odds, Caesarean section, Cancer, Care of the elderly, Change management, Community, Giving information, Helping others, Hospital, Human kindness, Human rights, Learning, Media, Midwifery, NHS Systems and processes, Nursing, Social media health care, Surgery, Teaching, Working from the heart

    r – Evolution in the NHS is happening right now 

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    Let’s go right back to 1980 the year I joined the NHS . I was a student nurse . My first ward was E1 a male surgical ward which was run like a tight ship. The captain was the sister and she ruled the seas – quite literally especially when I flooded the ward because I’d left the metal bed pan steriliser running during a ward round !!! 💦💦The consultant was paddling in his leather shoes, his trousers suspended at half mast like sails  – he never spoke to me but I was told off , humiliated and belittled. I wonder if that’s when I first saw the value of humour at work ?  Because suddenly the patients adored me ! Fast forwards 33 years to 2013 , you’d think I’d have learnt my lesson ! A busy shift and I was working on the beloved birth centre , women were spilling  into it because the delivery suite (a term I do not like – birth ward would be better) was full . A midwife friend asked me to keep an eye on the birth pool she was filling and I forgot as the woman I was with was overflowing with oxytocin and gave birth . So the best thing I hear is someone shouting ‘flood!’ Oops a daisy – run outside the woman’s room (not the room or my room – take note!) to find Mr Amu our lovely consultant standing in water laughing at me and saying “how do we sort this ?” My friend Carol the cleaner in hysterics with me as we rallied water suction machines , towels , sheets ANYTHING to stop the water moving further . Do you see the difference between 1980 and 2013 ? Now those of you who know me well know I’m a joker as I regularly shout to lovely Carol the cleaner “quick I’ve had another water incident !” Of course I’m joking and of course we laugh out loud and Carol tells me off – giggling . 

    The evolution is happening because  as the years have passed social media has been accepted as a form of communications and is effective connecting more staff and service users than emails and/or phone calls. However much more than that NHS staff can find out what’s happening (or not as the case maybe) either within their own trusts or in other trusts they may never ever visit or work at . By sharing evidence, good practice  , learning from others and communicating openly we are slowly stamping out poor practice and improving quality . Patients talk to staff within an open forum , staff read more articles and are constantly trying to improve the patient experience . 

    For me I think the lightbulb moment has been that I can make a difference , I can challenge practice and I allow myself to keep learning, growing and connecting . I’ll take you back to 1980 – all I knew was where I worked – now I see so much more-  and the wonderful people I’ve met on social media ? Well we would have never met ! So thank you social media from the staff and families of the NHS.

    Let’s keep on evolving 
    Thank you for reading 

    With love  , 

    Jenny ❤️