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 ❤️

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 role of L❤️VE in healthcare 

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

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

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

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

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

“We are all one another” 

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

Thank you for reading 

With love , Jenny ❤️

The fable of the napkin folder 

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❤️