Tuesday, 25 September 2012

Feel the fear............. and do it anyway

This week has seen the launch of the Freedom For Birth DVD; over 1000 hostings of the film, across 17 countries were simultaneously held on Thursday 20th.  I was quite late to the proceedings in terms of organising, but I had a small, yet perfectly formed (!) group, attend my home on Thursday evening (including my 13 year daughter).

Within a few minutes of the start of the film, tissues had to be shared.  It was a hard and sad film to watch, to see how far some country's will go to control birth and to 'manage' birthing women; a violation of human rights.

In my small (but perfectly formed) group, we spent time after the film discussing, sharing ideas and thoughts, trying to understand where we could perhaps make a difference, what we could do on a local level, how we could encourage women to take charge of their own choices and bodies, and how we can protect midwifery in its own right.  The thread - as in the film - that kept emerging, was the FEAR that prevails in and around birth; of course, this is not a new topic in childbirth, fear, for a variety of reasons, has been part of childbirth for millennia, but we seemed to have reached an all time high - from both women and health professionals.

So what exactly is it we are frightened off?  Trying to answer this question is like trying to capture moonlight in our hands; you can see it, it's in front of us shining like a beacon, yet it moves around, changes, and although it is can be bright as day and pulls us in many ways (even if not scientifically proven), moonlight is not tangible.

Following the evening, I invited a lovely third year student to come out with me.  This student should be counting down to the end of her training, but at the moment she is so disillusioned with her journey, she is not sure how she will make it through this final year.  This intelligent, questioning, reflective woman who is following her vocation and who clearly has the potential to become a 'with woman' midwife, may become another statistic of those students who don't make it to qualify.  We shall call this student Sophie:

Sophie accompanied me to a consultation with a couple who would like to book me as their midwife.  This professional, well-informed, capable couple have already made many decisions around their pregnancy, including choosing, amongst other things, not to have routine ultrasound.  Sophie and I spent time reflecting the consultation; she wondered if I worried about attending a birth where no ultrasound could reassure me baby was 'well'; she wondered if I worried that if a women who chose not to have routine bloods might be anaemic; she wondered if I worried that a women might refuse to take clinical advice I offered.  She did a lot a worrying.  Underneath all this however, it was apparent that Sophie's trust in nature, in women, in birth is being slowly eroded; she has been 'taught' to have a deep fear of the pathological - instead of a deep respect and acknowledgement that
 "Some births in some circumstances sometimes need some help", Mary Cronk.  
As for me, being questioned and exploring these questions enabled me to reflect on my practise; and what emerged for me was that as a midwife offering continuity of care, a relationship of trust emerges with  women, we have time to explore their health, nutrition, and self-care.  Concerns around the 'motherbaby' well-being can be picked up quickly as listening to the woman, feeling her baby grow, and being involved in all aspects of her care enables you to identify changes that (as a registered health-professional) you respond to.  Supervision is also a big part of my practice, as I will talk to my SoM about putting into place plans and documentation for women who may be making choices that challenge the 'status quo'.

So how do we work in a culture of fear?  How do we empower women to trust their bodies? How do we inspire the next generation of midwives to practise autonomously - and without fear, but with respect?

In all honesty, I don't know!  But, I plan to - as long as I am capable - try my best to work towards answering those questions; to protect birth; protect women; and to protect my profession as much as I can.  Burn out is high when you are passionate, so of course this needs to be balanced with protecting me (and my family), but I find it hard to sit still for long, or to ignore what my heart and soul is shouting.  I shall, as long as I can, feel the fear...... and do it anyway!
“The best thing you can do is the right thing; the next best thing you can do is the wrong thing; the worst thing you can do is nothing.” -Theodore Roosevelt
angela x

Sunday, 16 September 2012

How it feels to be a midwife

Sometimes, I hate being a midwife, and consider on a fairly frequent basis that I might leave the profession.  My problem is however, that midwifery is an intrinsic part of who I am; it is my calling;  my vocation; my life.  And as much as I hate it, I also love it passionately and I know there are midwives out there who will be nodding in agreement to these thoughts.

I remember so vividly the day I actually qualified as a midwife and the day my NMC Pin number dropped through the letter box.  I spent the next few weeks like a small child telling anyone who would listen that 'I'm a midwife'; I sang it round the house (albeit out of tune), I danced around my garden, and I posted it on facebook.  I really wanted to skip down the road shouting it too, but managed to restrain myself from actually doing that.  Still, there's time.

Anyway, after three years of blood, sweat and lots and lots of tears (a bullying NHS culture and colleagues ensured that) I had finally made it to the other side.  Alive, sadly not well (it took a long time to recover emotionally), but I had made it!!

I never practised in the NHS, but chose to go straight into Independent Practice; I had a midwifery partner and mentor to support me, and despite others doubts, I felt confident and competent to practice autonomously.  I had ensured throughout my training that I had gained a good understanding of the knowledge and skills I wanted under my belt (suturing, home birth, water birth, physiological third stage) etc..  Not always easy, and one of the few in my cohort qualifying with such experiences (that's a whole other issue in it-self!), but with some fantastic mentors and a lot of effort on my part, it had paid-off.

Midwifery is such an amazing profession; but there are so many politics involved, so many issues, so much angst that, at times, it's hard to remember that.  I can only write about midwifery from my view point as an IM; I have a deep respect for my NHS colleagues who work to be the best midwife they can, often under difficult conditions, and although I have worked a few 12-hour shifts on a busy labour ward, I am not in a position to comment about how it feels to be part of the system.

So, how does it feel to be a midwife?...........

When you are invited to care for a family during her pregnancy and for the birth of her baby, you are given a great gift: you are given the gift of Trust, of Respect, of a deeply personal Relationship at a vulnerable time in a woman's life.  You are asked to ensure the well-being of the Mother and her baby, to work in partnership with her, to empower her to make decisions and choices that will affect her health, her baby's health, and eventually her potential to labour and birth with confidence and self-belief.  
This feels like magic; like warmth filling your every cell; like the last piece of chocolate cake nestled on your plate.  It feels like a weight on your shoulders; have I done enough? have I put into place the appropriate advice, plans of care, evidence based information? have I documented it?! Do I convey my belief in her and in birth at every given opportunity?
When you are called to a birth, there is no feeling like it; the wait is over; but the work is just beginning.  Finally, she is labouring; you have put your life 'on-hold' for the past few weeks, you have kept your phone by your side, you have turned down that glass of wine, the invite to a trip that is just a little too far away in case 'the call' comes.
This can feel like coffee when its been burnt - looks amazing but the taste that lingers can be bitter.  It can feel like being invited to the party of the year, but then being grounded when they day arrives! It can feel like your life is passing as you watch from the side; like you are present but not fully participating; like a small shadow lingering over your shoulder.   
In the dark, small hours, I stumble from my bed to reach for the phone; I know it is my client and I hear her husband speak to me: "she want's you to come".  I check she is well, baby is moving, any concerns?  All good, her husband confirms.   I prepare.  Wash, brush teeth, dress - I pretend I am quiet, my husband tells me other-wise.  I breathe.  Deeply. And centre myself before I climb into the car.  I know where I am going as I have been there many times, my equipment is already in the car - always ready in the car.  I think; what do I need to be aware off, will my children be OK, how long might I be gone?  I hope and trust all is well.  You never stop thinking as a midwife; it's just you learn to do it quietly and calmly - that art of 'drinking tea intelligently'.

As labour unfolds, you appear calm, confident and relaxed.  You trust in the process - this is essential: if you do not trust the mother, her labour, her body, then your emotions will affect the birth and the potential outcome.  Without this innate belief you can not be a midwife.   Inside, you are quietly noting where she is in her labour, what you might need to do - or not do - to help and support.  Birth approaches; you breath.  Deeply.  Emergency equipment to hand (just in case); you watch.  Patiently.  And you lovingly encourage the mother to work with her body; you do not tell her what to do.  Her body knows, her baby knows.  As her baby enters the world, and the mother reaches for her child, you calmly, quietly check all is well.  You breathe. Deeply.
And you remember; you remember why you love midwifery, why you answered the calling to be 'with woman'; why birth is the most amazing event to witness, and why women are courageous and inspiring.  You remember why you do this.  It feels like Christmas morning; like the first sparkling frost of winter; like tasting your first bubbles of champagne; like nothing else on earth.  It fills your heart and soul.

A mother meets her baby after an emotional birth;
I was honoured to welcome two of her babies into the world
Midwifery is a roller-coaster of feelings; it is good, bad, beautiful, challenging.  It is rewarding beyond belief, and frustrating beyond measure.  It is a battle of wanting to be the best that you can, in a climate of fear and control and politics.  Midwifery is a way of life; it's not a job to come into because you like babies, or because you're good with people, or because you need a change.

Sometimes, I hate being a midwife, and as much as I hate it, I also love it passionately;  so, for as long as I still love it, and the women I serve, I shall continue on my midwifery journey.

Ask yourself this; how do you feel about midwifery?

angela x

Sunday, 9 September 2012

Tea & Knitting

This week there has been a lot of poor journalism around a maternal death following a home birth.  There have also been a lot of opinions about where women 'should' give birth, safety of birth, midwives and so forth.  It tires me; the questions we should be asking are how can we best support women who do not wish to give birth a clinical environment, and how can we best support midwives to enable this.

However, I fear these debates will just go on and on, so for now, I have decided to focus on something a little more positive; the art of knitting......

I have (slowly) been catching up with some of my midwifery reading; I subscribe to various journals, and one of my favourites is the ARM 'Midwifery Matters' journal.

In the Summer 2012 issue, there was a synopsis of the on-line debate on the ARM forum regarding Knitting, and whether is was acceptable for midwives to knit at births.  Sadly, some HoM's did not feel it appropriate for midwives to knit at births, and midwives have been informed that it is 'unprofessional'.

The late and very gifted Tricia Anderson spoke and wrote about the art of 'drinking tea intelligently', a phrase which highlights how midwives may appear to be doing very little, but are in fact intuitively, patiently, quietly, observing and listening to the mother as her labour unfolds.

Midwifery is an 'art and a science': one midwifery skill that is undervalued (I feel) is the art of recognising where a women may be in her labour from her body language, the sounds she makes and  the positions she adopts - not from a vaginal examination to asses what her cervix is doing.  When a midwife is quietly present in the back ground, she sends a strong message to the mother: "I am here, you are safe, all is well."  The quiet midwife can recognise when a little more support might be needed and welcomed; gentle massage on the mothers back or on her sacrum, a calmly spoken word of encouragement, the passing of a cold flannel to cool her face.  Sometimes, these actions need to be directed to the father, who is doing a wonderful job, but who may also need reassurance and encouragement.

I recall visiting a labour ward not too long ago to drop some samples; I was welcomed by a young, newly qualified midwife who was sat at the reception desk.  From one of the labour rooms, I heard the distinct sounds of a women who was labouring strongly, who was working beautifully with her body, and who was clearly pushing spontaneously as the strong surges urged her to bare down.  The midwife, in her smart crisp uniform and shiney bright name badge called to her colleague; "do you think that women is fully?  maybe we should go in and check (VE) her."  Slowly, another midwife took it on herself to see to the woman, who was alone with her partner.  At that moment, I feel such a deep sadness: I felt sad that this midwife could not clearly recognise the sounds of labour, that the woman did not have a midwife by her side, and that our 'professionalism' was represented by a uniform sat at a desk.

So back to knitting; I loved the response in the forum from Linda Wylie, a Midwifery Lecturer in Paisley who posted:
"I take a session with my student midwives in which my opening gambit is - today we are going to learn to knit.  I then go on to talk about masterly inactivity as described my Mary Cronk."
Perhaps, if this was a compulsory part of midwifery training for all students, we would have more midwives qualifying who were confident to keep their hands busy and off the woman; who were tuned into the sounds of women and their labour, who felt content to sit quietly in the back ground (and not the midwives station?) and who understood the significance of 'drinking tea intelligently'.

I decided a couple of years ago that I needed to learn to knit.  I was content to sit in the background at a birth, but knitting engages the mind in a gentle repetitive activity.  Knitting is easily transferable.  You can pick it up.  Put it down.  Stop if its annoying the woman.  Start if you need to keep your hands busy.  And all the great midwives knit (in my romantic mind anyway).  Knitting reminds me of the wise women, the elders of the community sharing their skills and knowledge with the younger women; it reminds me of a time when we slowed a little, and it reminds me of my time at The Farm (with other amazing midwives and Ina May Gaskin) where we spent time together creating crafts and remembering the ways of women.

So I knit; I've knitted bags, flowers, tea cosies, scarf's, animals to name a few.  But mostly, I knit baby hats; these are simple, require no pattern, and are a gorgeous gift to give to the new mother for her new baby who has arrived earth-side.


Tomato Hat

So I urge you fellow midwives, student midwives and aspiring midwives to take up your needles and start a (quiet) revolution.

Knitting is very conducive to thought.  It is nice to knit a while, put down the needles, write a while, then take up the sock again.  ~Dorothy Day

Happy knitting!

Midwife angela