Being busy as a midwife, Birth, Compassion, Courage, culture in nhs, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, leadership, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, NHS Systems and processes, Night shifts in the NHS, Obstetrics, organisational development, shift handover, Student Midwives, Working from the heart

This is the way it’s always been – Labour ward night shift to day shift handover NHS ❤️

You may find yourself on a NHS Labour ward at approximately 7am one morning . Everyone is assembling for morning handover . Over the shoulders is being lifted up into bobbles and held back by clips. Pens, hand-creams, mints , note books , mini hand gels all squeezed into powerful pockets. The “not allowed” mobiles are hidden from plain sight “just in case my son/daughter’s school need me” or to “google something”

Some night shift midwives sit in the office desperate to get home – they look worn out and you want to hug them saying “you will go home on time” but you know it’s a lie Other midwives are out of sight – they remain “with woman” in rooms praying that the handover will go smoothly with minimal interruptions. They want the transition from one midwife to another to be compassionate, woman centred, slow and not hurried .

“Don’t forget the midwife on the birth centre – the woman she’s midwifing is in the pool and about to give birth any minute” says the maternity support worker as she leaves . “Has that Midwife had a break?” – “Not sure” comes the reply.

Drs hang around to chip in with their findings and recommendations as well as chomping on leftover unappetising snacks from the tea trolley. The wheeled aluminium “redeployed” dressing trolley cocoons several slices of curled up toast covered with re solidified butter and cups of cold tea in a hard steel exterior as if to say “this wasn’t my original job”

Seats are hard to come by and woe betide the future midwife who gets a chair before a senior Midwife . Some staff arrive late and hide just behind the door pretending they’ve been there all along – but they did go home late last night . Not one manager in sight .

There are comments circulating “I didn’t leave until 10pm last night!! ” “I’ve only had one day post nights now I’m back on days” “my son is poorly but I’ve sent him to school” “how is ***** in room 2?” “who is in theatre ?”

The labour ward lead’s face demands silence – report starts 3 minutes late – you can taste the angst .

The night staff are supposed to finish their shift approximately 15 minutes after the day shift start theirs . The night shift rarely leave on time and luckily someone has the foresight to recognise that the maternity support workers can go home as their reinforcements have arrived to take over – they like the new shift midwives and Drs smell of new freshly applied deodorant . Many perfumes and aftershaves mingle and brighten up the stale office air. The virtual RHS of the NHS in one tiny space.

Now do the math -for one lead Midwife to hand over the cases and care of 8-16 women to the other in just 5 minutes (depending on the different labour wards in the nhs ) so that the day team can split and go to their allocated families, THEN have another more detailed handover (but VERY similar in principal to the one in the handover room) is nigh on impossible- in fact it is INCROYABLE.

So many night staff leave late – some have many miles and hours to drive or travel in a post nights shift state of mind in order to reach the comfort of their own slumber stations. Some wisely choose to pay to sleep in hospital accommodation as they daren’t risk driving. Others travel as they don’t want to be away from home , they need to be up at 2.30pm to collect their children or their children’s children from school and then possibly cook dinner then prepare themselves for their third or fourth night shift .

Staff leave but not before putting their “time owing” in the designated book – it’s not paid you see – even thought leaving late is beyond their control . This is the NHS

So what’s the solution ? I’m not sure there even is one. If you compare the way office workers start their day there is a great disparity happening between humans who work.

It’s about time staff handover had a shake up – be punctual, be succinct , keep your opinions out of report , respect ALL. Allow each midwife to handover each women / family she/he is caring for with the back up of a written SBAR and encourage the lead midwife to take a step back . Someone somewhere must have an idea ??

It’s a handover state of mind .

We are all leaders

Thank you for reading

My thoughts

Jenny The M ❤️©

Courage, culture in nhs, leadership, NHS, NHS Systems and processes, Psychology, Respect

The Art of Leadership © Jenny Clarke

So many books , blogs , articles have been written about leadership and what it means to be a leader .

Bad, poor and insufficient leadership will and does impact on many lives within the work environment as well as lots of public places that we visit – poor leadership highlights faults in schools , places of education, libraries, cafes , shops and transport among many others.

In the NHS frontline employees exist within the world of patients , colleagues, service users and relatives. Sometimes in their lives those employees cross from that “safe” world to become a visitor in it as they help their own relatives at appointments, visits to accident and emergency departments, hospital wards , maternity units and may even become service users themselves.

Today I took my family out for breakfast. My daughter and her partner, my son , my niece and her daughter (my great niece) . Four of us had variations of the same breakfast , one had a routine breakfast, my great niece had a children’s portion of an adult meal and we played around with the coffee choices . The young woman who served us kept her cool all the way through the order and never once did her smile drop , “Katie” said “yes” to all our demands and agreed to everything. Even though I could feel the eyes of the person behind me boring a hole into the back of my head , Katie was impervious to this . So in my view Katie is a leader she is an ambassador for the place we ate at . Because of Katie we will go again – separately or together.

Leaders are people who give others positive experiences, they are kind , compassionate and caring . Leaders understand. Leaders don’t embarrass people in front of others or put themselves first . Leaders don’t embarrass themselves – non leaders do .

Leaders put others first -right at that moment when others need to be put first . The nurse who helps the elderly man through the heavy non-automatic hospital doors is a leader . The cleaner who stops doing his job to show someone the right way to a department is a leader .

The manager who pulls a Midwife out of a room (where the midwife is caring for a woman in advanced labour) to discuss “an issue” is not a leader . The professional who berates a colleague in front of other colleagues is not a leader . The colleague who stops the professional from doing this is a leader . The junior Dr who answers the labour ward phone because everyone is busy and tries her best to deal with the call is a leader .

A leader doesn’t brag , belittle , gossip or drag down . A leader is self effacing , true , shows continuous integrity and raises others up .

A leader simply goes about doing the best she/he can to make life better for others and this in turn will make her/ his own life more enjoyable.

Leadership is not about control but about uplifting others ❤️

Look for the leaders where you work . Aspire to be like them – make a note of what it is about them that you admire.

Put some of that magic into your own self at work .

If you’d like to read another blog I have written about leadership for NHS Leadership Academy called “Leadership Is an every day event” then please Click here to read

Be kind ❤️

My thoughts

Thank you for reading

JennyTheM ❤️

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
  • 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

    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

    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, 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 ❤️

    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 

    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 ….. 

    Babies, Being busy as a midwife, Birth, Compassion, Courage, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, NHS Systems and processes, Obstetrics, Patient care, Respect, Uncategorized, Women's health, Women's rights, Working from the heart

    With woman midwifery 

    ❤️Before I start I’d like to thank Soo Downe for using this photo of me with my pinards in her slides during this years EMA ❤️ &  thanks to Jacque Gerrard RCM for letting me know. 

    Hello , are you a midwife ? Have you ever heard or said any of the following sentences ? 

    “I’m coming in the office for a few minutes , they don’t want me in there all the time” 

    “I’ll leave you in peace for a while – you don’t need me here all the time” 

    “I’m giving them some time to themselves whilst she’s in the early stages” 

    There is evidence and research to prove unanimously that women who have continuous one to one care have less pain relief , more incidence of normal birth , less perineal trauma and feel more positive about their birth process . As midwives there’s always information to share and explain that the woman may not know about . I also view my role as a guardian to the partner making sure he or she feels involved and free to ask questions . So the next time you hear yourself or a colleague say “I’m leaving the couple I’m caring for as they don’t need me in their birth room all the time” just remember leaving them  isn’t evidence based practice – staying with them totally is 

    Resources on continuity 

    http://onlinelibrary.wiley.com/store/10.1002/14651858.CD004667.pub5/asset/CD004667.pdf?v=1&t=iwl6t8eo&s=72d734e7de6a3665a8d183e2d5df1492e37dc2ec

    http://www.sciencedirect.com/science/article/pii/S0140673616314726

    http://www.sciencedirect.com/science/article/pii/S0266613816300572 

    Antenatal education, Anxiety, Birth, Breastfeeding, Caesarean section, Compassion, Courage, Fear of Birth, 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 Systems and processes, Obstetrics, Patient care, Post traumatic stress disorder, Postnatal care, Psychology, PTSD, Respect, Skin to skin contact, Women's health, Women's rights, Working from the heart, Young mothers, Young women

    Fear of birth 

    How can midwives help women who have a fear of birth ? 

    If you meet pre labour I cannot over emphasise the benefits of using a doula service – doulas connect with women and support them through pregnancy , labour, birth and the postnatal period – I value all doulas and I have learnt so much from them . 

    Sit beside the woman at her level , listen carefully with your eyes and your  ears . Demonstrate that you accept her fear as real and tangible and do not dismiss  it by saying “you’ll be fine, lots of women give birth”. When as a midwife you first meet a woman, it’s crucial for you to have open body language which means arms by your side , warmth in your eyes, and you should display love and truth . Ask the woman if she wants you to hold her hand , this is a connective proces and a simple yet effective of cementing your relationship with her . 

    Help the woman to gain a rapport with you and confidence in herself by demystifying some of her previous experiences  eg the gas and air didn’t help last time , I tore badly last time , I failed at breastfeeding last time. this time it just might . Be a source of knowledge and light for her .  Explain that you are with her that you love your job and you will be her advocate throughout .  

    Explain the process of pain in the cervix and why relaxation can help , use mindfulness links for her to listen to and actively take part in them with the woman and her partner to show your commitment to them both . Teach her that an internal examination is about choice, consent and that she is the one in control with an ability to stop the process at any time . Also explain her human rights matte in labour. . The woman may decide against internal examinations – be with her in this decision. 

    Hold the woman’s hand when she is talking to you , this will let her see that you are kind and that you  want to help her . Say things like ” I can see vulnerability in your eyes , tell me how I can help you , I am with you” “how are you feeling at this present moment? ” 

    Ask what her fears are – one woman I met recently was so scared , she thought that she might die in labour – this may seem irrational but it’s acutely important to know that these expressions of fear are very real to the woman herself . 

    Don’t talk about feeding intention , sometimes a woman’s confidence and belief in herself are knocked for six when there have been difficulties with breastfeeding and this can manifest as fear in labour . Discuss instead why her newborn craves for skin to skin with her at birth and that these physiologically magical hours are also to help her feel validated once she has given birth . 

    Help the woman to focus on the moment not what might happen this is mindfulness in labour.

    If a woman has had a straightforward birth before , her perception of it is what matters not what the notes say or the fact that it appears to have gone smoothly. 

    Try your best to stay in the room most of the time , even use the ensuite in the room yourself once you have asked her permission to do so . Your aim is to to reduce her anxiety and fear of being left by the midwife .

    Handover information to the team on shift about the woman and her fear of birth so that staff enter the room peacefully and introduce themselves . If someone enters the room and doesn’t introduce themselves, do it for them. 

    Ensure that the partners voice is heard and that they see you are trying to help by using open questions . Learn what they do , how they met and see their love for one another . 

    Don’t push the woman to have stronger analgesia , the key is give information. It’s crucial to give full explanation of all analgesia and their effects not only on the woman but on the baby and its ability to feed after birth . The pain is the woman’s pain and she must feel heard regarding her analgesic choices. 
    Never underestimate the value of finding  a midwife that knows the woman and also suggest aromatherapy. Frankincense is wonderful scent that reduces anxiety and if used in combination with other scents has a calming pain relieving quality . 

    Keep the room darker and ask staff to be respectful by not  entering the sacred birth room – interruptions increase adrenalin response which blocks the production of oxytocin and if her partner can get on the bed too this helps the woman to feel safe and loved . 

    Explain that you will not talk loudly during the birth and also try not to leave the woman afterwards , complete all notes in the room . Sometimes the most vulnerable time for a new mother is immediately after her child is born . Staying with her to help with positioning and handling of her baby will serve to strengthen her own belief in herself .

    Avoid using terms such as “good girl” use the woman’s name to speak to her so that a sense of trust is built upon . 

    Explain why prolonged skin to skin contact will help the woman after the birth , it is revalidating

    If you think she might need your help with a shower or bath that’s fine – ancient cultures have washing rituals and cleansing is sometimes quite cathartic for a postnatal woman plus you are showing that you care about her and reaffirming that human kindness makes a difference to someone’s experience .

    It’s important to be aware of fear of birth and how it manifests in women sometimes it’s difficult to recognise  in the antenatal period and might not be disclosed until labour . Women with a fear of birth  must’ve given time , feel listened to and feel supported . 

    Whichever way the birth takes place stay with the woman , and be a constant for her . 

    Read as many articles as you can about fear of birth let women know that you understand , follow @FearOfBirth , Yana Richens is a consultant midwife at University College Hospitals London NHS Trust who has just submitted her PhD on fear of birth , she has extensive knowledge and experience . Also Kathryn Gutteridge aka @Sanctummid who is a consultant midwife at Birmingham Women’s who recently co- hosted a tweet chat on  the @WeMidwives platform together with   @TheLovelyMaeve  Maeve O’Connell (a senior Irish Midwife who has also submitted her PhD) . The tweet chat discussed  the subject of Tocophobia . 

    Lastly try to write a birth story for the woman from her newborn . When a woman sees words on paper that reflect how she gave birth and her newborns belief in her the effect is indescribable . This will pass into the next generation and you will be affirming birth to many others who read the letter. Never underestimate the effect that your actions , inactions or displays of love , kindness and compassion will have on a woman and her family , they will unknowingly to you. Quite simply your support kindness and compassion will last much longer than a lifetime. 

    Thankyou for reading and thank you to wonderful Claire Harrison midwife and friend for believing in me and inspiring me to write this piece .

    Love from Jenny 💛❤️💛XXXX

    Against the odds, Care of the elderly, Change management, Community, Compassion, Courage, Discharge from hospital, Helping others, Hospital, Human kindness, Human rights, Kindness, Learning, Media, NHS, NHS Systems and processes, Patient care, Psychology, Respect, Surgery, Women's health, Women's rights

     The role of L❤️VE in healthcare 

    I recently rewatched    THIS FILM   of Dr Donald Berwick giving the keynote speech in London 2013 to The International Forum on Quality and Safety in Healthcare. This presentation struck a chord with me . 

    In the NHS there are many systems and processes which promote working within the confines of guidance and staffing  . However, time and time again there seems to be omissions about how guidance can encompass love . When people love their job and they feel valued within their particular role the result is better health care . It can’t be a coincidence that this is because if you love your job then in effect you love the people you care for .  

    When we talk about “love” it’s sometimes misunderstood – actually being human is about loving others .

     I was once in an orthopaedic ward as a patient following an accident and had to have major surgery on my lower leg – a pin and plate and internal fixation , tendon repairs . This operation left me non-weight bearing for 12 weeks . My mobility was severely compromised . In the bed next to me was an elderly woman let’s call her “Sophie”. Each day I’d watch some staff forget to put Sophie’s drink within her reach and this troubled me greatly . I’d ask staff to move her drink closer and I was usually given ‘the look’ i.e “what business is it of yours?” In fact it was totally my business as a human to care about another human . So I made a decision that I’d make Sophie’s hydration my job and also the job of my visitors . Sophie had no visitors , she was confused and didn’t really talk much . I asked my family to bring her a few bottles of sugar free cordial and set about my mission . On a daily basis I hopped to her bed and made her several drinks over the course of the day – usually out of sight of the staff . I began to recognise when she wanted the toilet as she’d shout out , then I’d alert the staff . This went on over about 6 days and with my visitors helping Sophie was soon rehydrated and talking – in fact she was well enough to go back to the nursing home she had been admitted from . 

    So what made me do this ? I didn’t know Sophie and I could’ve just focused on my own recovery. In fact Sophie helped me to find the courage to use my crutches (something I was petrified of using) and she took my mind off my own pain and frustration . Much more than this however I saw myself as Sophie in years to come – ‘sat out’ in a chair unable to move or communicate , hoping for the staff to be kind , for the kindness of strangers to aid my recovery or to ease my loneliness in some way . 

    “We are all one another” 

    I never told anyone about this before except my family who were also directly responsible for Sophie’s recovery . You see the truth is we didn’t do it for recognition – we de it because we are human 

    Thank you for reading 

    With love , Jenny ❤️