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 

What exactly does a midwife do ?

What does a midwife do ? I was listening to a song on the radio and thinking about my job – what makes me love it like I do ? 

Yes of course I get frustrated but I have such wonderful moments of warmth and happiness – moments which stand still in time for me – as an example when I see a woman become a mother for the first time – when I see a father cry at the sight of his newborn , when I say to the partner of the new mother “GET ON THE BED!!” so he/she transform the bed into the family space and he/she looks at me in surprise – I also see sadness but my role is to make sure that during the sadness important memories are saved , like photographs , pauses in time and to provide reassurance that life will go on. 

I was with a future family a few weeks ago laying the foundations of the beginning of our relationship which would form the basis of labour care when the woman’s mother came in “I was your community midwife !!” I said to her ” you were very busy & I remember fitting in your antenatal appointments around your work commitments ” we hugged and chatted about our children. This wasn’t fate-  it was the universe playing it’s part re-connecting and connecting . 

I get to meet new people each day and become their friend , supporter , adviser , informer , personal assistant , carer , room service provider , finder outer , cleaner and enabler . My first aim when I meet a pregnant woman is to become her ally so that she feels safe and able to speak away . Tracey Emin the artist has released a series of neon light pieces and one of them really resonates with what I do as a midwife here it is “Keep me safe” 

Yes I do blood pressures  , palpations , put up infusions , cannulate , take blood tests ,give medications but I focus on the WAY I do these things – I always try to do them with kindness and explanation . Skin to skin contact should be facilitated with explosive kindness – midwives don’t need to touch babies as much as they do – I have now started to question my own practice about this. I see a real change in the behaviour of newborns when I handle them so I ask the partner to place the newborn on the scales in a prone position which reduces stress and crying in the newborn baby (after prolonged skin to skin contact of course!) and I direct the position of the newborn as a hands free situation – if I need to hold a newborn I think first “do I really need to hold this baby ?” And I talk to the newborn first explaining why I am going to hold and ask if that’s ok . 

At the moment there is a cloud over midwifery – will we be able to continue as exclusive care givers to women , families and newborns in pregnancy , birth and the postnatal period ? My answer to this is to ask every midwife in the UK the following  questions… 

“Are you or have you ever practised autonomously ? Have you ever overrid a decision by a consultant or senior obstetrician ? Or have you persuaded an obstetrician to change his/her mind about the plan of  care for a woman ? Have you worked on a birth centre ? Have you questioned why you are a midwife ? Have you looked upon guidelines as GUIDE LINES ? Have you spoken out in the operating theatre when you feel the woman should be holding the baby ? Have you changed a woman’s position in labour in order to facilitate and increased chance of vaginal birth ? Have you avoided man made oxytocin by 1.dimming the lights in the birth room 2.shutting the blinds 3. Not allowing other staff to come into room to look for equipment ? 

If you’ve answered YES to any of OR ALL of these questions – then you are a midwife my friend . 
Thank you for reading , with much love , Jenny ❤️️

Ps as usual I LOVE any feedback ❤️️

With woman midwifery 

❤️Before I start I’d like to thank Soo Downe for using this photo of me with my pinards in her slides during this years EMA ❤️ &  thanks to Jacque Gerrard RCM for letting me know. 

Hello , are you a midwife ? Have you ever heard or said any of the following sentences ? 

“I’m coming in the office for a few minutes , they don’t want me in there all the time” 

“I’ll leave you in peace for a while – you don’t need me here all the time” 

“I’m giving them some time to themselves whilst she’s in the early stages” 

There is evidence and research to prove unanimously that women who have continuous one to one care have less pain relief , more incidence of normal birth , less perineal trauma and feel more positive about their birth process . As midwives there’s always information to share and explain that the woman may not know about . I also view my role as a guardian to the partner making sure he or she feels involved and free to ask questions . So the next time you hear yourself or a colleague say “I’m leaving the couple I’m caring for as they don’t need me in their birth room all the time” just remember leaving them  isn’t evidence based practice – staying with them totally is 

Resources on continuity 

http://onlinelibrary.wiley.com/store/10.1002/14651858.CD004667.pub5/asset/CD004667.pdf?v=1&t=iwl6t8eo&s=72d734e7de6a3665a8d183e2d5df1492e37dc2ec

http://www.sciencedirect.com/science/article/pii/S0140673616314726

http://www.sciencedirect.com/science/article/pii/S0266613816300572 

Compliance and the art of compassionate rebelliousness 

As humans we are encouraged to comply from the moment we are born . We are weighed , a hat is placed on our head. The media, tradition, education , culture, peers, history and many more all  step into our tiny lives on a huge platform telling us we must not be different 

We hear statements like this every day 

“Does your baby sleep well? ”

“My baby rolls over now does yours? ”

“Are you STILL breastfeeding ?”

“Don’t touch the beautiful fossil on display that was formed millions of years ago – you might break it!!”

“Do your homework” often heard said by parents to 5 years old children 

“Pass you exams and you’ll do well”

“Don’t argue back” 

“Don’t touch , play nice , keep clean , stop asking ‘why?’, sit still, don’t question , clean your room , you’re too quiet , you’re too outspoken , pay your council tax, keep your home clean , revise , work hard , don’t take your dog on the beach , don’t sit on the grass , do not be selfish , speak when you are spoken to , take your medicines ”

I’m not for one minute suggesting that we all dash out and start parking on yellow lines and refuse to pay bills . What I’m trying to say is do we teach our children the art of non-compliance ? Do we actively seek to help them see that it’s ok to say no to to certain things in our life and to put our own selves first ? Do we understand that self care should be 80/ 20 ? 80 for ourselves 20 to others ?Do we encourage that it’s ok to have a different mindset ? 

Now imagine the following statements 

“Hi welcome to our shop , we encourage your children to touch the displays with your support”

“Please find enclosed your contact of employment , within this organisation we actively encourage staff to be radical and challenge our services in order to improve both patient and  staff experience. We do not wish to stand stand still as an organisation  . We evolve only because our staff evolve us”

Change for me 

What exactly sparked my thoughts for this blog ? Well on Satirday I finally got a new mobile phone , I’ve had the same one for four years and I’ve been driving my family crazy . My old mobile would randomly delete tweets as soon as I tried to open them – but strangely the rebel in me quite enjoyed this 😂

On a daily basis I respond to tweets, DM Twitter messages , emails , notifications , questions and phone calls from other midwives (mainly) and future midwives seeking support, guidance ,conversation   , kindness, responses to ideas or a plan to meet up. I  try my best to help others who ask me for help because that’s what being human means to me – to help others  . The text deficit in my life felt a bit good to be honest and then I realised that my family would probably text me more than communicate with me in the methods mentioned above . I was putting others before them – so I got a new phone . 

How strange that @JennyTheM avoided change !! I wasn’t avoiding change I was rebelling against the system for my own good, thinking that one less method of communication may give me some space for self care and mindfulness BUT I was also being blinkered and not opening myself up to the benefits of a new phone . Anyway as usual I have digressed ! (Nothing new there I hear my friends add !) 

So , back to compliance – I was adding the wonderful Whattapp to my new phone and I saw my daughter’s profile picture .The photograph shows my daughter sat eating an ice cream on some grass right next to a sign saying “PLEASE KEEP OFF THE GRASS” – instead of feeling annoyed , embarrassed or wanting to say “why did you do that?!” I felt a surge of pride . My daughter was sat carefully , she wasn’t digging up the grass , she had taken her shoes off and was enjoying a still moment in time  . Here was MY daughter – a rebel . My heart felt so full I just can’t  explain it in words . Here is the photograph 

  

The NHS and employment compliance 

Within the NHS , current systems mean that we must comply with such things as uniform, behaviour, policies, contacts , orders , emails, training , shift patterns , meal breaks, and also hierarchy . 

Our short lives begin the science of compliance the moment we are born . Girls wear pink , boys blue . I didn’t know I was going to have a daughter when I was pregnant with my first child so I bought baby clothes in every colour but pink . Over the years as I’ve berated myself for my daughters lack of girly outfits as a neonate but NOW I now see that this was due the rebel in me and also my desire to allow my children to be who they wanted to be . My parents did nothing to ‘girlify’ me or my sisters . I was  encouraged that being different was ok . However I wasn’t told by them that being different would cause me to ‘fit out not it in ‘ and also that I would face challenges both in my personal and professional life for my non-conformist ways . I am happy to report that social media has blown this out of the water , I connect with other  of the same ilk . Other  “compassion rebels” determined to care for others in a way that doesn’t always suit the restraining systems of the NHS . PLEASE NOTE that blaming is not my style I have to connect with others that are on the same mission as me . I’ve found my tribe and wow it feels good .  
It’s time for the NHS to value rebels and this is highlighted in the latest release of  ” Let your workers rebel ” published by Harvard Business Review  . It’s so important that parents also stop trying to conform their children into society as individuality is not only what makes us human it is an evolving process and part of humanity  .

Suggested activities 

Read more about rebel behaviour 

Joint the school for health and care radicals  HERE  is the first module 

Get yourself on Twitter and be present in the 21st Century 

Meet up with like minded souls 

Consider blogging 

Keep compassion at your core 
“Fit out don’t fit in” one of my quotes 
Thank you so much for  reading . I would value any feedback ❤️

With kindest love and compassionate rebelliousness 

Jenny ❤️

Ps I leave you with my poem inspired by Natalie Linden’s fab conference in Worthing on the subject of courage in practice 

  Î

r – Evolution in the NHS is happening right now 

Let’s go right back to 1980 the year I joined the NHS . I was a student nurse . My first ward was E1 a male surgical ward which was run like a tight ship. The captain was the sister and she ruled the seas – quite literally especially when I flooded the ward because I’d left the metal bed pan steriliser running during a ward round !!! 💦💦The consultant was paddling in his leather shoes, his trousers suspended at half mast like sails  – he never spoke to me but I was told off , humiliated and belittled. I wonder if that’s when I first saw the value of humour at work ?  Because suddenly the patients adored me ! Fast forwards 33 years to 2013 , you’d think I’d have learnt my lesson ! A busy shift and I was working on the beloved birth centre , women were spilling  into it because the delivery suite (a term I do not like – birth ward would be better) was full . A midwife friend asked me to keep an eye on the birth pool she was filling and I forgot as the woman I was with was overflowing with oxytocin and gave birth . So the best thing I hear is someone shouting ‘flood!’ Oops a daisy – run outside the woman’s room (not the room or my room – take note!) to find Mr Amu our lovely consultant standing in water laughing at me and saying “how do we sort this ?” My friend Carol the cleaner in hysterics with me as we rallied water suction machines , towels , sheets ANYTHING to stop the water moving further . Do you see the difference between 1980 and 2013 ? Now those of you who know me well know I’m a joker as I regularly shout to lovely Carol the cleaner “quick I’ve had another water incident !” Of course I’m joking and of course we laugh out loud and Carol tells me off – giggling . 

The evolution is happening because  as the years have passed social media has been accepted as a form of communications and is effective connecting more staff and service users than emails and/or phone calls. However much more than that NHS staff can find out what’s happening (or not as the case maybe) either within their own trusts or in other trusts they may never ever visit or work at . By sharing evidence, good practice  , learning from others and communicating openly we are slowly stamping out poor practice and improving quality . Patients talk to staff within an open forum , staff read more articles and are constantly trying to improve the patient experience . 

For me I think the lightbulb moment has been that I can make a difference , I can challenge practice and I allow myself to keep learning, growing and connecting . I’ll take you back to 1980 – all I knew was where I worked – now I see so much more-  and the wonderful people I’ve met on social media ? Well we would have never met ! So thank you social media from the staff and families of the NHS.

Let’s keep on evolving 
Thank you for reading 

With love  , 

Jenny ❤️

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

Sharing evidence in the NHS 

We’ve all been there – in a busy clinical area and a person or family  are advised there is a change in care due to clinical findings, investigations, laboratory results . Time is limited but each person being counselled varies in their knowledge, understanding, intelligence and how they process the facts that are  imparted to them. It can’t be a one size fits all but how exactly do health professionals communicate quality evidence to the people they care for and maintain an individualised approach? 

Several NHS trusts are going paperless with leaflets available on line. This is a way forward but we must ensure  there is access  to computer or a phone with wi-if access . Some health care users may not want to admit they are technophobic, don’t have a computer or laptop or perhaps cannot read and/or write. I promote the use of libraries and also show how to access the hospital free wi-fi . It’s important to flag the hospital wi-fi which should be available for all staff ,visitors and patients – Trusts that don’t provide this are failing their patients and staff . Access to wi-fi has been jokingly added to the Maslow triangle 
  

but on a serious note it’s standard in cafes, restaurants and hotels so please NHS follow suit – our business is hospitality after all . 

Questions to ask about giving information 

  • Is it relevant ?
  • Is it current ?
  • Does it link to evidence and research ?
  • Who decides how in depth it should be ? 

Giving a leaflet is simply  a starting point for a wider discussion it’s not a final statement . As health care professionals we should be constantly asking women and families “is there anything you need to know ? Any questions you have? ” as well as promoting a learning environment . We are helping women to become leaders for other women when we give valid , useful information out . There is no excuse for us to say  “I wasn’t asked” anymore. 

Health professionals must start the spark that gives the public a thirst for knowledge about their own health . I recently counselled a woman about carbon monoxide(CO) – she didn’t smoke but two of her close family members did . I offered them all Carbon Monoxide screening . The two family members CO levels were 1. Above 30 2. Above 25 . The non-smokers was 19 and wait for it I also measured my CO as a control – mine was 15 . I then realised I’d been in a closed room with the family for over an hour . The CO had affected all of us . This led to a discussion about the effects of smoking , the safety of nicotine but the dangerous effects of carbon monoxide and the way the tobacco industry makes an addictive product with hidden perils . The family chose smoking cessation as the results of the screening test surprised them (and me !)  I didn’t nag them I befriended them and helped them to focus on how they could remove the product from their lives and not their guilt . 

Below is a recent article by Jonathan Cliffe Midwife about personalising care for every woman – published in the British Journal ofMidwifery August 2016 . 

 

The current financial status of the NHS is forcing many  trusts  to cut back on small things, but I believe that it’s the small things that make the NHS wonderful. The fact of the matter is we are here to provide a priceless service to families, parents and people. If we keep our focus on doing the best we can do each and every day by imparting the evidence which applies to the individual , looking at how the individual might help us to gain new knowledge, opening our minds to  improving outcomes, valuing staff and patients alike  then the only way  that the NHS can possiblY move  is in a toward direction. 
I suggest you google “How to share evidence –  NHS”  you might find some valuable information to help your own NHS trust . 

Thank you for reading , please leave a comment .
With love , 

Jenny ❤️