Category: Psychology

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Talking with strangers and unconscious bias in the NHS Maternity System

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This blog is dedicated to Sandra Bland with love to her family #SayHerName ❤️

I have just finished reading the book “Talking to Strangers” by Malcolm Gladwell

The book is a critique of how we approach others through our body language speech, demeanour plus the various cues that we interpret or misinterpret according to our own life experiences, culture, colour , upbringing, religion or non religion , education , training ,inner feelings at that time and individual roles plus many other factors too numerous to list . One particular woman who in the book was Sandra Bland a black woman who was forced to change lanes on a highway because a police car was approaching with speed – the officer totally misinterpreted Sandra’s distress at being pulled over – he wasn’t kind with his words or approach and this led to Sandra being wrongfully arrested and she died in her cell three days later the verdict was suicide . When you listen to the recording of the officers first interaction with Sandra you can sense the irritation and suspicion in his voice as well as the tone he uses. He doesn’t see that Sandra may have vulnerabilities and that she is trying to calm herself by lighting a cigarette .

As a midwife I have witnessed disparity of care towards women depending on their social status, background, colour, culture and ethnicity- something I have challenged throughout my career . These experiences have often placed me in some difficult situations with colleagues. On one occasion I refused to allow someone from finance dept into the woman’s labour room . This years (2019) RCM International Day of the Midwife campaign was around Midwives as defenders and I wrote a blog about my interpretation of this . We must approach women placidly and an excerpt quote from the poem Desiderata by Max Ehrmann © 1927 illustrates this rather well.

“GO PLACIDLY amid the noise and the haste, and remember what peace there may be in silence.

As far as possible, without surrender, be on good terms with all persons“

Unconscious bias is something we all have – This animation by Professor Uta Frith of The Royal Society explains unconscious bias in a concise way . It’s the 21st Century – time for all NHS staff to be educated, assessed and held to account around the subject of unconscious bias plus to question their own personal identity around this issue .

Here is a photograph of part of the philosophy of the Royal Society panel members – a philosophy for the NHS .

Whilst writing this blog I also came across this refreshing blog post for By ‪@SuzRankin‬ CEO of Ashford and St Peters NHS Foundation Trust, Chertsey , Surrey .

If you are a midwife I want you to start to question the way you speak to women and families that you meet and whether you treat each woman or person exactly the same despite their background , culture , colour, sexual orientation and education. Make an attempt to hear yourself as the woman hears you – be patient and thoughtful with your words and actions . Watch how other midwives speak about the women they care for (at the bedside and in the office ) and monitor one another for unconscious bias .

Did you see someone give the woman everyone recognised from a TV programme better care than the woman who arrived unannounced from the local homeless shelter ?

Please question everything you see and if you talk about it more when reviewing cases of different women you might see a pattern start to occur – that’s what you need to change. Does your incident reporting system include statistics on race , sexual orientation, religion and ethnicity? If not how can such incidents be thoroughly evaluated ?

How do you talk to the women you meet as strangers ? When you show patience, kindness, compassion and understanding you are building on the relationship and helping the woman to feel safe . This behaviour has an effect on the woman’s oxytocin response as her adrenaline and cortisol will be reduced as well as her own fears . You are putting her at ease – becoming a friend . If on the other hand you are brusque , rushed , impatient and critical you will put the woman on edge and increase her fear , pain and cortisol which will inhibit oxytocin production.

Are you pre judging a woman when she phones up the hospital for advice ? Does that judgment impact on the way you interact with the woman ? Do you feel calm or under pressure? Are you more or less patient with her in comparison to someone else you’ve recently cared for ? Are you imparting information and evidence of equal quality or do you feel a change in your own demeanour which may make the woman feel uncomfortable without realising?

Reflect on a situation when you didn’t feel listened to – that may have been a complaint to a store or a the way an employee at a restaurant/ service / shop spoke to you – do you recall how you were made to feel or how you reacted?

Black and Asian women have a higher risk of dying in pregnancy as the November 2018 MBRRACE-UK triennial report shows and as midwives we must question why this is happening as well as campaigning for this tragic disparity to end .

I will leave you with a quote by Paul Coelho

Further reading…

Thank you so much for reading

– Jenny ❤️

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

#BirthLeadership ©️ is Born

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

#BirthLeadership ©️

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

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

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

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

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

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

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

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

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

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

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

Women need to know we care ❤️

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

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

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

Here are a few Birth Leadership examples

SkinToSkin in the operating theatre

Not weighing a baby until after it’s first feed

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

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

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

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

Supporting a woman compassionately through a difficult birth

Helping a woman to avoid unnecessary internal examinations

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

Holding a woman’s hand in an emergency situation

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

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

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

Thank you for reading

Yours in Birth leadership love

Jenny ❤️

PS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“do to”

but to

“be with”

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

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

❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️

Three stories of defending

Read on reader ….

Story one

The elective premature Caesarean birth – a courageous Midwife

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

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

Story Two

The “Failed” Induction challenging a decision

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

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

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

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

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

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

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

Story Three

Rebalancing the birth hormones

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

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

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

All was well

I am a defender ❤️

Summary

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

Stay curious and keep defending

❤️We are defenders❤️

#IDM2019

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

Thank you for reading my blog .

Yours in midwifery love

JennyTheM ❤️

Stay curious

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

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

The Art of Leadership © Jenny Clarke

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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 ❤️

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

Loss of control – a reason for fear of birth ? 

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

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

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

COMMUNICATION 

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

1.2.2 To ESTABLISH communication with the woman:

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

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

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

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

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

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

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

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

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

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

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

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


Yours in midwifery love 

Jenny ❤️

Birth, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, NHS, Night shifts in the NHS, Obstetrics, Patient care, Postnatal care, Psychology, Student Midwives, Women's health

How to keep your ‘Midwifery Passion’

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Ideas to help midwives through NIGHT SHIFTS the past couple of weeks I’ve been on night shifts – hence my temporary disappearance from Twitter . I have been forced to practice self-care and be mindful of my own health and wellbeing in order to not only survive night shifts but also to ensure the women in my care were kept safe. A huge part of my role  is to support women and families and also to be a team player by helping and listening to my colleagues of all disciplines. Factor into this the additional pressure like teaching my body to sleep in the day and stay up all night – all this has an adverse effect on causes on my hormones and body  physiology – so it must be the same for any midwife working the night shift.

 I try my best to visit women who may still be on the postnatal ward (ones that I have cared for in labour or met antenatally) to offer a debriefing session and go through parts of the birth they may have forgotten- I find this helps me as much as it helps them . Women become tired during long nights of labour and may forget their own strength during labour and birth so I like to remind them. As midwives we must make a firm relationship foundation with the woman and her birth partner(s) and we must also display  love for our job and show it’s something we do because we enjoy it not because we have to – when did you last show that you love your job?  Women want to know that you care about them and getting food and drink in the middle of the night is a real challenge but I take it firmly onboard . I scour the fridges for left over unopened  in date sandwiches- dash to the vending machine to buy a packet of fruit pastilles or a small bar of chocolate , offer my pre-packed fruit salad, make toast and encourage food in labour – women use on average 150 kcal an hour in labour and it’s important to explain why you are encouraging eating .  Women don’t want to face a labour with a midwife who hasn’t slept or who is complaining about being at work . My philosophy the past two weeks has been to

  • Get some sunlight every day before bed
  • Eat a meal before work that will sustain me through the night – a balance of protein, carbohydrates and vegetables
  • Laugh with colleagues – I am quite well known ay work for my gangnam style dance so one night I was on the postnatal ward I danced in the office – the future midwives face was picture !!
  • Understand why I may have bouts of moodiness
  • Speak to a friend every other day
  • Walk my dog pre-bed and pre-work to ensure I am getting exercise and fresh air
  • Reduce my screen time – that includes Google and Twitter – I am on screen time at work with the maternity system online and screen time can affect our circadian rhythm.

Don’t underestimate how hard it is for me to get in from work and drive to the beach – I struggle, but I have noticed a definite change in myself during these nights and I am sure its because I have exercised prior to sleeping . I have also used some aromatherapy and mindfulness (which I do every single day – nights or days )

I prepared my fridge – chicken , vegetables , pre-packed fruit portions , cheese for protein in the night , and faced my dislike of drinking water . I googled jet-lag and circadian rhythm to help me face up to how my body might react and went in for the positive approach . I took the decision to walk on the beach with my Labrador puppy Buddie post each shift and eat my favourite breakfast sat outside my favourite cafe before I went to sleep. These positive  activities helped me to switch off from my shift , gave me a sense of wellbeing and also helped me to interact with others before I became a hermit for the day . Once home in bed, all curtains were closed and all lights switched off – as a visual hint to ‘popper inners’ those friends of mine who I adore as they pop in to visit me unannounced and I do love that but not on night shifts. I also prayed that my neighbours would be quiet and that their dog wouldn’t bark too much – it worked !!

Night shifts are special for midwives , the hustle and bustle of the hospital is turned down , the ward round is vanquished, the tea trolley is ever present and I can drink tea in the birth room with the families .

After night shifts it’s ok to feel tired and nap in the day – listen to your body carefully . Take time to recover post nights – don’t push your body beyond its limits thinking you are doing it a favour – you aren’t !

I’d like to dedicate this blog to all the midwives who work night shifts – and especially Olivia and Jude as they often discuss the effects of nights with me –  thank you to all NHS nightworkers  for all you do .

Further reading and resources 

information on The BODY CLOCK 

What is sleep drive ? Sleep drive and your body clock

Try a few of my ideas and see if they help your night shifts – I hope they do .

With kindness & midwifery love ❤️

Your friend Jenny

XxX

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 

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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 

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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 ❤️

Against the odds, Care of the elderly, Community, Compassion, Courage, Fables, Helping others, Hospital, Human kindness, Human rights, Kindness, Learning, MatExp, Midwife, Midwifery, New parents, Newborn, Newborn attachment, NHS Systems and processes, Patient care, Psychology, Respect, Teaching, Women's health, Working from the heart

The fable of the napkin folder 

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There was once a factory in a far away land . The factory owner Fred  took immense pride in his factory .

This was no normal place to work , the employees had to fold napkins at the same time as caring for an elderly person . This care involved mainly talking to the elderly person and making the person happy through conversation – this was an intrinsic  part of their work – but I’d like you remember that  the employee also had to fold napkins .

Suki was an employee at the factory , she was an amazing napkin folder and the top napkin folder at the factory . The factory owner raved on and on about how good Suki was at her job – he promoted her and used her as a role model of efficiency whenever he went to other napkin folding factories . Suki felt very proud and kept working hard .

One day Suki’s chair broke – so she had to move to another area whilst it was fixed . Suki sat next to Giles who was also a napkin folder – Giles wasn’t very productive but he did attain adequate levels of napkin folding  to keep himself in employment . Suki noticed amazing things about Giles he was working but also chatting away to his allocated elderly person quite a lot , the elderly person was called Gertrude . Suki noticed that Gertrude looked very happy and Suki suddenly realised that all the years at the napkin folding factory her own allocated elderly person had never laughed like Gertrude . 

The next day Suki went to see Fred the factory manager and told him about Giles & Gertrude . “I think we should watch Giles” Suki said . Fred the factory owner went to see Giles and immediately noticed how joyful he was in his work – Suki was happy but Giles had that extra ‘je ne sais quoi’ . The factory owner also checked all the records of all the elderly people that Giles had sat with whilst he folded napkins . A wonderful thing had come to light not only had no one complained but there were letters of thanks from families of the elderly people stating how kind Giles had been and recommendations for his promotion .

The next day Fred the factory owner made an announcement to all the people at the factory  

“All of us within this factory should give a higher priority to making each elderly person happy  over and above folding napkins. In this wonderful life  we are simply spreading kindness , compassion and the human spirit . Look at Giles and Getrude and the happiness they emit and share . ”

Over the next few months the factory workers tried their best each day to give their priority to each of their allocated elderly people. A remarkable thing started to happen – productivity increased and surprise,y more napkins were folded than ever before  but also the workers felt more valued  and much happier about being at work – plus much more than that the physical and mental health of the elderly people involved took a significant improvement – because in the end we are on earth to be human .

I hope you enjoy my fable . 
Thank you for reading 
❤️Jenny❤️