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

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
  • Being a mum, Communication, Compassion, New parents, NHS, parents, sepsis

    A little story of Sepsis

    A guest blog by my fabulous friend, Val Finigan 

    ‘I had an idea-to write a little blog every few months that would help the midwives and nurses at gtdhealthcare with their continued professional development needs, in preparation for revalidation.

    So here goes, my first blog on sepsis.  I hope that you all enjoy it –please do comment if it is of use.

    The idea of blogging is to share ideas and to embed ‘things’ into the blog that make shared learning easy. Story telling has become an important part of learning in healthcare.  Here I will share my two personal stories of sepsis and links to evidence based learning tools and red flag symptoms of sepsis.

    Sepsis is more common than a heart attack ! Isn’t that shocking?

    The 2015, NCEPOD report, ‘Just Say Sepsis’,  Identified an overall mortality rate of 28.9% per annum, at least 120 people die every day from sepsis in the UK alone.The sepsis manual 2017 (embedded) says “it seems highly likely that, across the UK, sepsis claims at least 46,000 lives every year, and it may actually be as high as 67,000”. Who would have thought that the figures would be this high?

    Sepsis that occurs during pregnancy is termed, ‘maternal sepsis’. If it develops within six weeks of delivery it is termed postpartum or ‘puerperal’ sepsis. Sepsis is one of the leading causes of direct maternal death in the UK. See maternal sepsis tools in the Sepsis manual 2017 (below).

    The HEE have developed a wonderful e-learning programme on sepsis which can be accessed via the web link below.

    https://www.e-lfh.org.uk/programmes/sepsis/

    They have also produced a short film that is really helpful

     

     

    Sepsis is a condition which every health professional might encounter, and which can touch anyone at any time. In general, patients developing sepsis aren’t ‘labelled’ as being at high risk for that condition (in comparison with, for example, a majority of patients presenting with acute severe asthma or diabetic ketoacidosis). There is no one ‘hallmark’ symptom or sign, unlike the crushing chest pain which the public know might indicate a heart attack.

    Because of this, patients tend to present to healthcare late, as evidenced by a 2015 report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) which found that, where patients were felt to have presented late to hospital, in nearly 60% of cases it was because they did not ask for help and the delays were typically measured in days rather than hours.

    The National Institute for health and healthcare excellence (2017) have also published guidance on the prevention and management of sepsis- to take a peek CLICK HERE 

    I have had two personal experiences of sepsis, in the days when little was known about the condition. 

    My first child had sepsis and septic arthritis at the young age of 7 (29 years ago).  She had suffered with recurrent Tonsillitis for two years and had been treated with numerous courses of antibiotics. She developed severe pain in her hip and over the next five days became increasingly ill.  An initial xray revealed nothing and because there were not hot spots seen, her symptoms appeared to become irrelevant; the hospital staff would not listen to me nor would my GP. Although I took my daughter on many visits to the GP and Accident and Emergency Department nothing was done. In fact I was labelled as an over-anxious mother and directed to the paediatric pain services to learn to control my daughter’s ‘discomfort’. 

    On the 5thday of her illness she was hallucinating, confused,her temperature was 35C and she was mottled and cold to touch, her lips were blue. I took her straight back to Accident and Emergency.  Two hours later she was in theatre and then spent 6 weeks in hospital on traction and two weeks on intravenous antibiotics, her reminder a scar from thigh to knee. 

    The final diagnosis came, Sepsis and severe Septic arthritis of the hip.

    We counted our blessings daily; if I hadn’t been the awkward mother the outcome could have been worse. The hospital offered their sincere apologies and lessons were to be learnt.

    One lesson I took from this-was always take note of what the parents are saying after all they know their child better than you do.

    My second child had sepsis years later.  Age 11 years; his tooth was broken when he was hit accidentally with a cricket bat. The tooth was crowned and the temporary crown kept falling off.  Sepsis was quick to bite (pardon the pun).

    This time there was a more rapid onset of symptoms. My son came in from playing out and said he felt unwell; he was shivering excessivelyand looked pale and mottled. His temperature was high, yet he sat firmly besides the warm hot radiator because he felt cold.  I took him straight to Accident and Emergency and the staff in this department were trained to spot signs of sepsis.

    Immediately bloods were taken, he was admitted and intravenous antibiotics were were administered within an hour of our arrival at Accident and Emergency. Two weeks later we were back home with a well child.

    So what can be learnt from these two examples of sepsis? The symptoms can be variable –take a look at spotting sepsis below. The onset can also be variable. There are red flag symptoms, early assessment, diagnosis and management are vital.

    Spotting sepsis FINAL.pdf

    Sepsis_Manual_2017_final_v7.pdf

    I hope that the tools in this blog are helpful and that it has been useful. Please do comment

    Thank you for taking the time to read it

    Val Finigan July 2018

    RM. IBCLC. RGN. PhD. MsC. BA (Hons). FHEA. QTLS. Honorary research fellow, senior clinical nurse gtdhealthcare

    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

    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

    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

    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 ❤️

    Birth, Communication, Compassion, Helping others, Human kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Newborn, NHS, Skin to skin contact, Student Midwives, Women's health, Women's rights, Working from the heart

    The future midwife and the midwife 

    A few weeks ago I was working with Emily Leeder a student midwife who has since completed her training and has now finished her time at my trust . I really like Emily she totally gets me and my sense of humour and she has picked up some of my traits – which is strange but lovely to see – I feel that when I do retire I will leave a little bit of me within Emily’s practice .  Emily also inspired this blog CLICK HERE TO READ about the importance of appropriate touch in midwifery . 

    We both saw the positive effect of a small glass of a well known energy drink (NOT Redbull!) made flat by stirring profusely and how women who hadn’t eaten in labour felt better after it . We christened it our ‘chemistry set recipe’ for an energy boost in labour .

    When we worked together we automatically shared roles and I think that neither of us felt controlled or ruled by the other – we were there for the women and supported them but we were in harmony as future midwife and midwife . Emily taught me the true meaning of mentorship as she messaged me for support and also wrote me lovely feedback for my revalidation.  I gelled with her and never felt judged by her or unable to ask if she knew something I didn’t . 

    A few weeks ago we were with a woman who was at the start of her journey to becoming a mother . With this wonderful woman was her partner and her mum . We were having a discussion about skin to skin and delayed cord clamping and I asked the woman’s mum if she had experienced skin to skin contact at birth  with her children. The mum said “not really , my baby was born then weighed , measured and checked by another midwife , whilst the birth midwife was helping me to birth my placenta and check if I needed stitches – which I didn’t – so then I was told to have a shower . Within half an hour I was transferred to the postnatal ward ” 

    My reply was off the cuff and I didn’t realise how funny it was until Emily had to leave the room crying in laugher . 

    I said “a shower ? You gave up skin to skin contact because someone told you to have a shower ?! We are mammals – imagine other mammals giving birth and being forced to wash within an hour of birth . In fact right here right now let’s just imagine an elephant giving birth to a baby elephant cub and one of the female elephants shouting out ‘Get into that river now & wash !’ It just wouldn’t happen would it – no one would argue with a newly birthed elephant mum would they ? ” 

    It really doesn’t seem as funny now but it’s left a great memory for me , Emily and the family – and the woman gave birth and did NOT get pushed into the shower at all . In fact she chose to have a wash a bout three hours later , after LOTS of skin to skin with her newborn ❤️
    Thank you Emily for helping me with my journey as a mentor – I’m always learning and I wish you well at your new NHS trust – keep in touch 

    This is my first ever scheduled blog and it’s for three reasons 

    1. Today will be the third anniversary of the day I started presenting to raise awareness of skin to skin contact – you can read the storify of the day HERE or just search #MAMMevent on Twitter 

    2. I will be presenting at Coventry midwifery Society today the # will be #CovBF17 

    3. To thank Sheena Byrom OBE for believing in me as a public speaker and also for friendship and kindness when life was tough for me . 

    I am proud to be a midwife 
    Love from Jenny xx 😘 

    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 

    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 ? 

    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 ❤️