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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 ❤️©

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

SkinToSkin poem © by Jenny Clarke

it really doesn’t matter where you are

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

The ultimate way for a baby’s life to begin

Is right next to her mother in SkinToSkin

Your baby doesn’t care what she weighs

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

SkinToSkin contact for babies 37 weeks or more

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

It helps stop separation of you and your baby

That’s a fact – no ifs,buts or maybe

Prolonged SkinToSkin makes you more of a team

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

SkinToSkin is no fad, craze or latest trend

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

your ears soon in Breastfeeding Week.

I have read all the research by the SkinToSkin geeks

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

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

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

SkinToSkin sets off behaviour ,keeps baby’s calm

Us humans are mammals -made to keep our young warm

So at birth just consider how your baby will feel

SkinToSkin will tell her –

YOU ARE the real deal ❤️

© @JennyTheM 27.3.19

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

Antenatal education, Babies, Being a mum, Birth, Children, Compassion, Hospital, Human rights, Labour , birth, Labour and birth, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, Postnatal care, Respect, Skin to skin contact, soeaking out, Student Midwives, Women's rights, Young mothers, Young women, zero separation

Newborn babies – photographed without their parents – my bugbear

Everyone who knows me knows that I promote , research and present about SkinToSkin contact . I know exactly why it matters to mothers , fathers and babies .

Just recently I’ve noticed an advert for an upcoming ITV series “Delivering Babies ” in which Emma Willis stars as a auxiliary nurse assisting on a maternity unit – the profile photo shows a picture of Emma holding someone else’s baby without any of the parents in the photograph – this is what prompted me to write this blog .

One particular bugbear I have is seeing a baby on a photograph with a health care professional without the mother or father being included in the picture .

I have discussed this with many future and new parents and explained that they are the guardians of the newborn – protecting it from unnecessary exposure to anything . At most schools there is a social media policy which prevents the posting of children on social media sites . However the same rules don’t seem to apply for newborn babies.

I see many programmes about pregnancy, labour , birth and the postnatal on TV which I choose to critique. Some I have given up watching through exasperation that the baby is not seem as a child of someone .

I have had heated debates with maternity managers , future midwives , midwives , maternity support workers about why a baby should not be photographed without any of its parents . I ask them this question “if you had a baby would you want it’s photo to be on someone else’s social media account , mobile phone or perhaps even framed on a sideboard in someone else’s home that’s not even related to you ?”

Just google “Midwife” and numerous photos will pop up of midwives holding someone else’s baby . There’s even one from Call The Midwife – time to rethink why these photos exist and consider the human rights of the newborn ?

Below are two collages I made following a google search – who are these babies and were the parents asked for full consent and counselled thoroughly about the fact that their babies would appear on internet searches ?

My other concern is WHO takes the photo ? If it’s on the parents phone and given to the midwife as a gift does that make it ok . What is consent ? Eg “could I have consent to use this photograph of me holding your baby to post on social media / put into a frame at home , look back on and wonder who that baby belonged to in 20 years time ” OR “could I have a photo of you as a family with me in the background which I will treasure and treat with respect , I will not post it on social media and it will remain a midwifery memory for me of meeting you ?”

In taking photos we must consider

Is it necessary ?

Please leave your comments below

Yours in midwifery love

@JennyTheM

Babies, Bereavement, Birth, Compassion, Dying, Grieving, Helping others, Hospital, Human kindness, Kindness, Labour , birth, MatExp, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, NHS, Obstetrics, Patient care, Post traumatic stress disorder, Student Midwives, Women's health, Women's rights, Working from the heart

A Midwife’s heart and caring for families through stillbirth ❤️

This is a very difficult blog to write . Yesterday someone highlighted a tweet to me about midwives and how they deal with the impact of caring for a family who may have to face the loss of a baby . It was to do with midwives knitting hats for stillborn babies .

I have been a Midwife to many women whilst they birth their baby who has died before labour starts . It broke my heart each time I cared for these families. However I saw the fact that I was allocated to care for them as nothing but a true privilege and joy . I wanted to make the moments they had with their precious child special , full of love and memories . I helped them take the best photos . assisted them through washing their babies and also knew that I had to give them time to grieve and to communicate to them through deeds not words that I was “with them” totally . I cried with them , held them whilst they sobbed , even laughed with them – which may sound strange but it’s true . I cooked for them , made endless pots of tea and I washed their feet . I saw in these women & men a strength that can’t be put into words on a blog . I recall walking a couple through a labour ward to a bathroom with their stillborn son , so they could all be together in the bathroom whilst the mother took a bath – they insisted I sat with them ,so I did – on the bathroom floor – I know these memories are as special to them as they are to me.

Midwives do not routinely get counselling post events like this – fire workers and police staff do so is the NHS missing a clue ?

In 2006 I reflected on an incident at work where a woman came in to be induced and when I put her on the CTG monitor, we discovered that her darling son was not for this world . I was devastated and had to arrange childcare so that I could stay with the woman & her husband post my 21.00 shift finish . Another thing. that also hit me hard was that the friend I asked to help me with my young family had no qualms about saying yes – I later found out that the reason was that she had given birth to a stillborn son many years before (she told me that she felt by helping me she was helping the parents of the stillborn baby ).

As I left the couple to go home much later , I wept from sadness for them and their empty arms as well as emotional exhaustion and was told not to cry by a senior member of staff. I couldn’t go into work the next day .

What transpired was an article about my reflection by Rosemary Mander . The mother became a friend of mine & I helped her with a SANDS event – I went to her sons funeral and this connection helped me to cope as much as it did her to have someone who saw her son like she did – as a beautiful boy .

It’s so important that we see our role as supporting parents through sadness & also happiness . The midwives who choose to knit hats are simply trying their best – they might not know what else to do – it’s s coping mechanism. You can’t train for events like these just like parents can’t prepare for this to happen to them .

I’d like to thank Rosemary Mander for writing around my reflection in 2006 , the mum & dad of the darling son that was born asleep for giving consent to publish my reflection all those years ago (you gave me the courage to show my emotions to other parents) and also to my friend for her kindness in caring for my family whilst I stayed with the family ❤️

Also thanks to @kwelsh1 for showing me this powerful sculpture by Albert Gyorgi called “Melancholy ”

it sums up how any parent who loses a child must feel

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 ❤️