How to keep your ‘Midwifery Passion’

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 

Fear of birth 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Love from Jenny 💛❤️💛XXXX

The natural caesarean / the gentle caesarean 

There’s a debate on Twitter this morning about the ‘natural caesarean’ as a term that promotes a positive experience of birth by caesarean. I don’t agree with the term and I think as health care professionals working in the area of birth we should ensure that every birth is a positive birth . Milli Hill started the The Positive Birth Movement  with this goal in mind (@birthpositive on Twitter ) 

Bearing this in mind I’d like to ask the following questions for you to consider and share with with your colleagues, family , friends , midwives and obstetricians . 
1. How many women who have an emergency caeserean and/or instrumental birth (forceps or ventouse) are given information in the antenatal period about the far reaching health and psychological benefits of skin to skin contact in this setting to both mother and baby ? 

2. Compare the above with how many women are given information about  skin to skin contact around normal birth ? 

3. Compare both to how many woman are informed that skin to skin is possible during manual removal of placenta and repair of any perineal trauma in the theatre setting ? 

4. Are women informed 

  • They can TELL midwives to defer the weighing of their newborn in order to enjoy the benefits of prolonged skin to skin contact 
  • That they should never be separated from their baby unless a clinical situation becomes apparent or they themselves choose not to have skin to skin contact despite being FULLY informed
  • That their baby could ‘self latch’ at the breast without any handling by staff and also correct its own acidosis and stabilise its own breathing because of skin to skin contact ? 
  • That skin to skin and early breastfeeding “Pronurturance ” is linked to a reduction in the incidence of  postpartum haemorrhage?  CLICK RIGHT HERE for the Pronurturance paper 
  • That if babies could talk they would choose skin to skin contact despite their birth environment 
  • That skin to skin contact is the building block for a persons social and psychological development 

The midwives and staff on social media who talk about caesarean are not promoters of it , they are giving women information about choice – so that if the operation (which is major surgery) does take place then these women are able to not only enjoy their birth experience but give their relationship with their baby the best possible start . 

I suppose it’s similar to the question “does having a teenage pregnancy strategy increase teenage pregnancy rates ?  (and I much prefer the term  “young women”to ‘teenage pregnancy’) 

Does having full information about your choices if you do go on to have a caeserean increase caesarean rates ? I don’t know the answer to either of these questions but I do know that the women I have assisted and sometimes fought for to have skin to skin contact with their newborns in different birth situations have all told me this 

 
-that they never realised the positive impact it had on them as a successful mother

To me this is enough .   
Thank you for reading 

With love , Jenny ❤️

I am also promoting #MatExp as a platform which enables and encourages discussion between women, families and health care professionals . 

The Gentle Caesarean – Gentle with what ?

Last year I was lucky enough to work in a general theatre for a week . I met a wonderful general surgeon and watched him perform bowel surgery . I noticed immediately how gentle and kind he was with the internal tissues and how calm and respectful he was not only towards the patient and his body , but also the staff in the operating theatre. All the staff admired this surgeon – you know when you can just tell ?  

I asked the surgeon afterwards about his technique and he said this

 “I always respect the tissue Jenny- tissues , blood vessels  , muscle and skin are part  of our human make up and being gentle with them means I am showing tissue respect and respect to the patient who is a fellow human . Being a gentle surgeon takes longer but believe me the outcomes are better and I know that there is less trauma , post-op bleeding , infection, pain and therefore happier patients and staff .”

Currently there is a lot in the news and emerging research around “The Gentle caesarean” and I am looking at this from a different angle  (and for those who know me well I don’t do acceptance well – I like to ask things so that others unable to ask might think differently ) so I am questioning what this term “Gentle Caesarean” actually means . Does Gentle Caesarean mean just the moment of birth or should it be right from the decision or choice of the woman to have an operative birth through to arriving home ? 

So for all those who work in the field of midwifery , obstetrics , intra-operative care, surgery , pain management -I would like you to watch a caesarean from start to finish and ask yourself “was that a gentle caesarean from that the moment that the woman arrived in theatre ? Was there gentleness with the woman’s feelings and choices ? Did the obstetrician, scrub midwife and others maintain gentleness towards the internal tissues and the to the baby? Was the transfer to the bed from the operating theatre table gentle ? Was privacy and dignity maintained at all times? 

Just because we have always done something a certain way does not mean that “the way” is always the best . 

I hope I spark someone to change practice and make “The gentle caesarean” standard across the NHS because then it will spread  globally – we must question on a  daily basis what we do and why we do it .
Thank you for reading , please leave feedback and / or share this blog with your colleagues 
With love and midwifery kindness , 

❤️Jenny❤️
Addendum today I am thrilled that The Times journalist Katie Gibbons has written an article about skin to skin contact at Caesarean  CLICK HERE to access or being the rebel that I am here’s a photo 😁

 

Memories of skin to skin contact 

Those were the days weren’t they? Or were they ? 

This week I met up with a friend (pseudonym Niamh) who is a mother of four. She recounted to me each tender moment that each of her children was born . The last three were born by Caesarean section . “Did you hold them straightway?” I  asked .

Niamh replied “to be perfectly honest no – I held none of my children that were born by Caesarean section immediately in fact not for severel  hours ” Niamh then recounted to me the birth of her son – when he was about 6 hours old she had still not seen him properly and asked a midwife how he was doing – the midwife told her that he was fine but due to breathing problems he was in an incubator . SIX HOURS !! I want to add that no one had told her until she asked . 

If you are a midwife , an anaesthetist , an operating department practitioner or a theatre nurse. If you work in an operating theatre , or  if you teach those who do -I want you to think carefully about why we must all strive to keep mothers and babies together in the theatre setting . 

I know it’s becoming more common for skin to skin to happen and I realise that if it’s not happening that to fight the system and challenge separation is difficult but we must keep moving forwards  . The reason is simple – skin to skin makes babies happy and it makes mothers happy and feel like mothers . It reduces postnatal depression and admissions  to neonatal units , I’ve even seen it stabilise a mother’s parameters. There is new evidence emerging to show that in effect if Nimah had held her son straightaway he may not have been admitted to neonatal unit with breathing difficulties . 

Skin to skin is human nature – we must tell women why it’s important not just ask 

      “would you like skin to skin contact ?” 

We need to say

 “If you hold your baby immediately against your skin and WE will provide help and support . As a mother you can instantly reduce the chance of your baby producing  the stress hormone cortisol and this contact can and does have a positive nurturing effect that is invisible as it happening.

As health care professional we must practice evidence based medicine and skin to skin is evidence based . We are responsible for teaching why it matters – not just throwing it into a checklist, box ticking exercise . 

The ‘Niamh’ I am talking about is in her late 70s – her children ages range  from 38 to 48 years of age . Niamh recalls each birth , each separation  but even more than that she remembers her feelings of despair at wanting to see touch and smell her babies but feeling like she couldn’t ask . 

That to me puts it all into perspective .
If you’d like more evidence here is some of the latest publications 
Pronurturance 

http://www.sciencedirect.com/science/article/pii/S1871519215003558

Skin to skin at caesarean 

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003519.pub3/pdf/

http://onlinelibrary.wiley.com/doi/10.1111/mcn.12128/full 

I recommend you follow the following people and organisations so that you can converse  with those who are champions for skin to skin contact 

@JeniStevensS2S @CarolynHastie @HeartMummy @FWmaternitykhft @KathrynAshton1 @Natasha47 @Csectioninfocus @hannahdahlen @bloodtobaby @AAGBI 

Please take a look at my “skin to skin FB page”  for more resources 

https://www.facebook.com/Mother-Infant-contact-skin-to-skin-in-the-operating-theatre-setting-445225315630071/ 

Thank you for reading  #Keepgoing ❤️
With Love , Jenny ❤️

A little book of labour and L❤️ve  

A while ago one of my dearest friends appeared at the front door of my home .When I say dear friend, she’s the kind of friend that you might not see for a few weeks or months yet when you do see her it’s just as if you saw each other yesterday- as if no time has passed since you last saw one another .You know what I mean – you both remain the same age as when you first met and restart  a conversation exactly where you left off . You know the kind of friend I’m talking about – one that will drop anything  anytime when he/she  hears those words “I need you”. That is exactly what she did for me and continues to do for me so many times I’ve lost count . She shows no judgment , never tells me what I “need to do” , doesn’t gossip and listens to me with true friendship and love in her heart for me , which is equally as strong as the love I have for her . 

Anyway back to the door – my friend was standing there and before she spoke I knew something was wrong , very wrong . I could tell in the wildness of her hair ,  the look in her eyes , the way she was standing and her sense of upset . I pulled her inside my home and hugged her . The news was that her 15 year old daughter “Verity” was pregnant .

We talked and I recalled a celebrity that once said ( I’m sorry but I’ve forgotten who it was) ….

” it might not be the right time or the right situation , but it will always be the right baby” 

I said those words to my friend , I listened , I didn’t tell her what to do I just gave her the love back that she’s always given me . 

The months went by and her daughter “Verity” (name changed for reasons of privacy)  was blooming , looking beautiful everything was going well . I sensed however that she was worried about labour and I decided to make her my “Little book for labour ”  I felt I had to do something to help her prepare in order to realise her own strength and to believe in her capability to give birth . I started the book I didn’t want to make it boring or prescriptive but fun and positive . I also realised the importance of going through the book , discussing induction of labour , vaginal examinations , acting on complications, early labour, food, and breastfeeding but most of all key support people and after the birth . 

So to sum up the book was a success with Verity . We held  a  “mini” Jen & Verity one to one antenatal group in my lounge which taught me things about not just what younger women want to know (perhaps women of all ages?) . I really don’t know if I could’ve written it in the same manner if I hadn’t made it especially for Verity . She calls me “Auntie Jen” so I wrote it not just as a midwife , but as her dear mum’s friend and as an “auntie”. 

Veritys baby is now over two years old and her birth was beautiful. I wasn’t there but my friend was ,they took the book in and read it . There were no complications and the birth was physiological . 

Last night I asked Verity if I could borrow the book back to look at it – I’d not seen it for over two years. Verity had kept it safe and sound – I was thrilled that she still had it . 

So here are a selection of pages from the book  – I am very proud of it but more proud of Verity and her beautiful daughter . It’s going straight back to Verity after I’ve published my blog.  (not her real name) 
Thank you for reading 
❤️Jenny ❤️

   
    
    
 

The UK Blog Awards 

I have entered this years UK Blog Awards in the Health Category to raise the public profile of midwifery in a positive light . 

Compassion is a crucial part of any midwife’s role and I find that blogging helps me to open the window of my midwifery soul through the written word.

It’s crucial that women and families have access to midwifery support now and in the future . Social media is a great way to connect to others and also to learn , inspire and lead. 

You can vote for me BY CLICKING HERE

Thank you for your ongoing support and for reading and sharing my blog . 

With love from Jenny 💛