Seeing the whole picture 

Each person we meet and care for  has their own story. 

As health care workers we must keep striving to tune into those that we care for – humility is needed and an ability to connect. Digital technology is a huge part of record keeping so it’s essential to realise that ‘CARE’ is not simply a tick box exercise but in fact a multi dimensional emotional process that may not have a solid beginning or ending . 

Trying to step into another humans story is a spiritual art form   – the way that we listen as well as the way we speak can have an immense impact on what a person imparts. A brusque manner can inhibit a connection, prevent sharing of valuable information, foster a disjointed attitude and is totally destructive to the priceless treasure of two way communication and empathy . A kind compassionate manner however, can help a person to open up and share information about themselves by helping them to relax and feel a sense of trust towards the other person. There are some people who have this off to a fine art and if you know such a person watch and learn from them you will gain so much. 

As midwives If we exude warmth and kindness we will send out positive connections – this will improve the oxytocin response and give women a feel good factor about themselves which will facilitate positive pregnancy ,labour, birth and breastfeeding . We underestimate the power we have to influence women and their ability to nurture themselves and their young . 

The midwife in the operating theatre setting who sends out signals of peace and calm by helping the woman to have skin to skin contact with her newborn is instrumental to the health of the world – she is brave and courageous and more than that she epitomises “human-kindness” itself.

The midwife who is able to read signals from the new father and help him to open up and see his strengths and yet embrace his own vulnerability is an asset to the family unit. 

The midwife who acts as an advocate for the same sex couple who want to avoid induction yet at the same time stay safe helps them to feel like they have been empowered and respected yet also like it’s their own choice . 

These are all examples of the wonderful work that midwives do and it’s time to celebrate all the admirable midwifery role models out there that inspire so many . 

Let’s all keep doing what we do well and try to improve a little each day . Let’s not stay still or remain where we are but let’s keep moving forwards for the mothers the fathers and the children of the universe. The world needs positive role models in midwifery some are visible some are hidden so seek them out shine a light on them and give them a loud cheer . 

Thankyou for reading – please be kind 

Jenny ❤️

“it just might just be you”

hope this poem gives you a view
To be kind to others & to yourself be true 

Hospitals, clinics & community work

Its fellow humans you’re caring for so please don’t shirk 

They need your love,passion, time & explanation  

Please focus on the way you give communication 

Consider your language & the way you speak

Empathy is strength , it does not mean you’re weak

Holding a hand & reassurance ain’t just talk 

Its shows through your eyes – means your walking the walk  

The person you are caring for is a human other

-a sister, brother,friend,father, mother

Be mindful of their thoughts and the way  they might be feeling

From an illness or accident that’s left them reeling 

Treat and approach colleagues with zero hierarchy 

collaboration doesn’t support any of that malarkey 

See the whole human, not  just the condition

Be holistic and please let this be your sole mission

Allow care,competence, kindness to guide you through 

As one day that “person”  – well it just might be you 

@JennyTheM 

Transfer from hospital to Community care – planning in maternity services 

There is so much written about discharge planning for Care of the Elderly / Unscheduled care / patients requiring rehabilitation .

Currently there are extra pressures on maternity services and I have set out my objectives as to why I want to discuss postnatal discharge planning below 

1.To highlight beacons of positivity 

2.To inspire discussion 

3. To make discharge planning an intrinsic part of the admission process 

4. To identity where a same day transfer should not be promoted

5. To make the actual ‘time of discharge’ a governance issue  

6. Share good practice and eliminate bad practice 

7. Raise the profile of effective discharge planning in maternity services 

I have learnt from others and by listening to families how the NHS could streamline the discharge process I’m certain that this would make a positive impact on staff time , families understanding , effective communication , reduce complaints and develop a well rounded understanding of the  discharge process. 

Going home with a newborn is seen as an easy and smooth process so my blog will try to help parents as well as midwives and maternity workers to see that this is not always the case. 

The best time to be discharged home is in the morning , however the pressure on postnatal wards is immense and they have one of the fastest turnovers in the NHS . So often we hear of women and newborn being sent home at ridiculous hours and  HERE is an article about this in Mother and Baby 

So how can we streamline the discharge process ? 

A. Find out if the family have transport home 

B. Start the discharge paperwork by checking address and phone number are correct 

C. Ensure medication to take home is requested as soon as possible 

D. Promote and explain why prolonged skin to skin contact will ensure not only breastfeeding success but also maternal and newborn wellbeing and that continued skin to skin contact is important as well as talking to the newborn and feeling calm (it’s crucial to discuss co-sleeping and I usually direct parents to ISISSLEEP as well as explaining – I’m not going to go into depth about this now, but  I do with parents.  

E. Ask about support at home – visitors who come and help are very valuable and aid recovery and coping . At the same time it’s important that the new family have some time alone in order to gain confidence in being new parents and learning to recognise various cues that their newborn makes .  

F. Go through thoroughly signs and symptoms of illness for mother and baby and mention sepsis – any infection caught early improves the outcome. 

G. Ensure all levels of midwifery staff are competent to discharge women and babies home – in busy times when there are pressures on the service this will facilitate an “all hands on deck” situation 

H. Employ a discharge facilitator who can assist clinical staff to organise the paper trail 

I. Have a generic checklist to refer to primarily so that women and families can see what the process entails and secondly so that staff do not miss any of the steps involved and this will avoid mistakes and maintain communication at all levels .  

J. The first point of contact in regard to any queries should always be the labour ward and / or community midwife . Midwives are responsible for postnatal care up to 6 weeks post birth – I am proud to say that when women present at labour wards they are seen quickly – a walk in centre or a triage service are not equipped to deal with postnatal care – midwives are . 

Explanation, discussion , allowing time and two way communication are all integral to a successful discharge process . I like to tell families that the discharge is in effect a transfer of care to the community midwifery team and also what to expect from the visit. Midwives do not expect families to be up , dressed and ready with the house perfect – they are visiting to see how families  are feeling and coping . To assess if the baby is feeding well and to give support . 

Rushing the process because of pressure has no value and affects communication in a negative manner – it’s so valuable to discuss why discharging takes time at antenatal group and have information on discharge at clinic appointments . 

Ideas such as group work on the postnatal ward to increase questions and save time are being developed in various NHS trusts and discharge guidelines should be updated regularly to match the process. 

Talking about safe regular analgesia and how to take medication will improve recovery , reduce infection , help mobility and be key to reducing venous thromboembolism . Perineal pain is real – it hurts – but in the first day it may not be as bad until the woman arrives home and starts to question her pain threshold . Pain management is part of postnatal care and can make the difference between good recovery and feeling awful for days . 

Perinatal mental health care is gradually improving and it takes skill and experience for midwives to recognise it if the woman is reluctant to disclose . Continuity of carer and knowing ones midwife makes talking about postnatal depression and anxiety easier – but we still have a lot of work to do . HERE The Guardian highlights perinatal anxiety . Post Traumatic Stress Disorder is now a recognised illness caused by trauma around birth – communication and compassion at birth can reduce this and I recently received a letter from a woman telling me that skin to skin contact helped her to cope during an emergency situation – so there’s something to consider .  I am proud to know Emma Sasaru who has PTSD and courageously BLOGS  in order to help other mothers to recognise the signs and how to seek help . 

As the midwife completing the discharge YOUR responsibility is also to ensure the baby is feeding  and that you have observed a feed and given the mother support. Talking about maintaining milk supply and support groups as well as how to recognise that the baby is thriving must be discussed . It’s just as important to explain and know the family understands how to make up milk if the baby is not being breastfed.

 The neonatal examination is not a future prediction of health it just says the baby is fine at the moment it is done . Any signs like continuing sleepiness, a very quiet baby , poor muscle tone and slow weight gain might be indicators  of poor health – mothers usually have an instinct about these things so listen well and get the baby seen by a paediatrician – don’t manage the baby at home without senior input . 

Finally time of discharge is an issue – do families reall want to go home at 23.00 or 3am ? It’s a personal choice but CHOICE it must remain there is no place for sending women and newborns home in the middle of the night – does it happen in any other department? I have never heard of children being sent home in the night or elderly patients so why should we accept it for women or maternity services?  If you have concerns that families are bring sent home at inappropriate times there is action you can take – escalate it to your line manager , fill out an incident form , discuss at your team meeting and raise with your governance lead. Ask other units what they do and be pro-active . 

The main point I want to get across is that discharge from hospital is a complex process . It is much more effective when there is two way communication between midwives / obstetricians and families . Talking about going home must start as soon as the admission process starts. Discharging someone home must be a high quality , thorough , kind and efficient task. It must also be individualised and embody compassionate care . Use your skills in effective discharge and teach them to future midwives – it’s important to share good practice. 

I hope I have raised your interest  in discharge planning . I appreciate and value all feedback and understand there may be some points I have missed . My main aim is to promote thought , discussion and change . 

❤️Thankyou for reading  

Love Jenny ❤️

Who interrupts skin to skin contact? 

When a newborn is gently placed into skin to skin at birth with its mother complex intricate physiological and psychological processes begin. As midwives we must be mindful of the next stage and fight back the strange urge (that seems to be a part of our midwifery culture) to move the baby . 

Evidence shows that  if the baby is moved after any period of time before the first breastfeed then the whole process must begin again, it’s like restarting a stop watch. 

Patience and a detailed awareness about the physiology of breast feeding , mammalian responses ,the effects of intervention and why an early breastfeed will be an indicator of long term breast feeding success must be reinforced . The continually evolving fresh bank of ever expanding new research is gaining momentum. Emerging facts  about  ‘skin to skin contact’ such as it’s ability to reduce postpartum haemorrhage (this article can be read HERE ) , also the positive effect that skin to skin has on long term maternal mental health should be making us all sit up and think . If newborns experience skin to skin contact for long periods of time both at and post birth in combination with positive parenting the newborn will grow into a child and then an adult with an increased ability to socialise,  be compassionate and be kind. 

One thing stands like stone to me though and it is this 

Which mammal do we know that puts its trust in another mammal and then allows that other mammal  to take control of and/or disrupt the connection between the mother and the newborn ? 

I have had so many emails and messages from mothers, fathers  , future midwives , midwives , doctors ,peer support workers, friends  and family about ‘who owns the baby ?’ I feel the time has come for us all to challenge the constraints put upon us and to encourage women to shout out … 

 “this is my baby – I grew this baby I nurtured this child – I am the birth mother and I will not let anyone move my baby without my consent – I am part of the dyad and we work together – we two are one ” 

I would like to see more written about skin to skin wishes for birth if the situation becomes medicalised or complex – so that the other parent can have skin to skin contact . I would also like  other health care professionals  to consider whether they should be holding a baby without a reason. A family must also be fully informed and educated on the unseen detrimental effects of separation on the birth mother and the newborn . 

Can we honestly say that we inform future parents that if their newborn is moved out of skin to skin contact too soon that it will affect their baby’s ability to breastfeed and the mothers ability to lactate  ? Do we inform women that skin to skin contact gives a feel good factor ? 

Have we made birth a production line business ? For example how many times have you heard “is the woman in ‘Astra birth room’ ready for transfer to postnatal ward yet ?” Without the woman herself being asked ? Do we have a  constraint around time of birth to time of transfer to the ward ? Is it fair and equal that woman who give birth within a Midwifery Led Unit / Birth Centre can stay in the room they are in until they go home ? Whereas women who give birth on a labour ward are moved and then even separated from their partner in some hospitals ? 

These are all my thoughts and I am writing to provoke questions in my own practice as well as trying to help families and midwives . My skin to skin journey is an ongoing one and any feedback will be valued and appreciated 

Thank you for reading 

❤️Jenny ❤️