Wednesday, 20 February 2013

Call the Midwife – or call a midwife you know and trust?

I enjoyed reading Sarah Johnson’s recent blog post on call the midwife.  I LOVE call the midwife and read the books when I was student; how I dreamed of working in that way – a local midwife, on her local patch, working with the local women, caring for them in their own homes.   

For most midwives, this way of working is a million miles away from the reality of midwifery care within the NHS; birth at home is no longer the ‘norm’, midwives work in large centralised units, women are very unlikely to be cared for by a midwife they have ever met, normal birth rates are incredibly low and the use of analgesia and the associated risks and side effects high.  Sarah suggests that birth stools are ‘standardised equipment’ in units, and women birth in up-right positions: statistics suggest otherwise, with the NCT citing in their research that less than 40% of women are encouraged to be mobile, upright and off the bed and their backs.  I myself have visited units where birth stools may be quietly gathering dust in the corner, where huge, shiney new units are built with just one ‘token gesture’  birth pool (despite NICE guidance stating that birth pools should be available to all women as an effective form of pain relief) and where one-to-one care is not always achieved for women in labour.   The NHS offers the best it can on a shrinking budget, with a hard working yet disillusioned work force, with a growing population, and with women presenting with more and more complicated pregnancies. 

My dream of practising as a 1950’s midwife might not quite have come to fruition, but I am honoured to have carved a way of working which comes as close as possible: I care for the same woman throughout her pregnancy, birth and postnatal period; I care for women and families in their own home; I attend home births (and follow the woman into hospital if plans change).  I may not have a bike (and am about to invest in a 4x4 to make work life easier), but I do carry my own equipment and have a big ‘Midwife on Call’ sign to hang on my dashboard when I am with a woman in labour! 

When a woman in my care goes into labour, they can call a midwife – they can call a midwife they know and they trust, who will be by their side until their baby is tucked up safely in their arms, who knows all about them and what is important to them.  That is Independent Midwifery – the recognised gold standard of care, a choice for women outside of the NHS.  And it is under threat.  Just as that 1950’s midwife is no longer recognisable, so too, might be Independent Midwives; EU directives, insurance issues, and a government failing to deliver on its promise to really offer choice are seeing to that.

So, women, mothers, midwives, fathers, grandparents – if you LOVE Call the Midwife like me, if you LOVE the idea of calling a midwife you know, if you LOVE the idea of care in the home being the norm, then make sure you make a call to your local MP and tell them that!

You can find out more about this issue by visiting

Saturday, 9 February 2013

fear + loneliness = Brave?

I have often been told that I am 'brave' for choosing to be an Independent Midwife; I wrote about this a long time ago and can honestly say I have never felt brave, or really understood why fellow midwifery colleagues consider me such.  I am just a midwife, working to support women, some courageous and strong, some needing support to find their inner strength, but all who wish to have the bulk of their care outside of the NHS system, with a midwife they know and trust.

I attended a beautiful home birth this week; I was not anticipating to be the primary midwife, but the woman's own midwife was caught in Jury service and unable to attend. I gathered myself together and headed off to the birth - I knew the woman and her family having supported them as the second midwife with their first baby.  As always, I mentally prepared myself, and drew inner strength and calmness into my being.  I was not aware that I would be doing that many times in the course of the woman's labour..........

Birth works: if you follow my blog you will know that this belief is deep in my inner core.  BUT, and there is always a BUT in nature, sometimes birth changes and sometimes nature will challenge us, humble us and remind us that she is a force that we cannot always control, always predict, always guarantee.  After the baby made its way earth-side (a beautiful, calm, wonderful HVBAC), the woman's body was not (for whatever reason) willing to release the placenta; I was concerned.  Too much bleeding necessitated a decision to transfer; a serious maternal obstetric haemorrhage occurred,  a wonderful team of NHS staff worked very hard to save a very compromised mother.  And a very shaken midwife was left holding the baby...... until he was safely tucked back with his mother later on that day.

So, back to my 'bravery'; it was with a sudden clarity that I understood why people believe me to be brave - and it has nothing to do with me.  As I watched the team work around the woman (and I was in total awe of the NHS staff and so very, very grateful that when obstetric care was needed, we had access to it), as I supported her, reassured her, even prayed for her, I have never felt so alone in all my life; the safety net of the NHS is a strong one.    Perhaps this is the reason midwives do not challenge guidelines, or policies not based on evidence; perhaps this is why the vice on midwifery is so strong.  Not that I am brave, but because the 'safety' of working within the NHS is so strong - and watching that team, I think I understood why people would not want to 'risk' that.  Being the lone voice, choosing to leave that safety net, to be fully autonomous, to accept full accountability..... can be very lonely indeed.  The fear of loneliness is why people believe I am brave.

I am not 'brave' for choosing to be an Independent Midwife; it is a wonderful way of working.  It is 'the gold standard of care'.  It is rewarding, challenging, exciting, scary, bumpy, amazing, tiring.  It is working to keep birth normal - and safe. I am not brave...... but if more midwives were given the support to work outside of the NHS, if the government fully supported choice and continuity, if the RCM would acknowledge a group of midwives who work outside of the system, it might be a little less lonely.

angela xx

He who is brave is free. 
Lucius Annaeus Seneca 

Read more at 

Friday, 1 February 2013

Birth Works

There have been some awesome blogs this week from Midwives and from Women, as well as some interesting news headlines; I love reading blogs that inspire me, challenge me, and get more women and midwives thinking about birth and midwifery skills.

Last week I facilitated an 'Inspirational Birth' Study day, covering physiological birth: I have wanted to run this study day for a while, but when it came to planning the actual content for the day, I found myself procrastinating.  Fear in part; worry that I didn't know enough to fill a 6 hour day; concern that I wouldn't convey the message I was hoping it turned out it was a great day: I had forgotten actually just how much I have learnt in my journey as an Independent Midwife, and watching the 'light bulb' moments was very rewarding for me as a facilitator.  

In the current midwifery climate, there is little scope for physiological birth - and I don't state that lightly, as I know that is a direct criticism of maternity services.  How do I justify that statement?  Women are designed to give birth; sometimes, in some circumstances, some women may need some help (thank you Mary Cronk for that beautiful phrase), BUT we know that the vast majority of women are NOThaving normal, straightforward births - and even fewer are experiencing physiological birth  (there is a difference).  Birth Works, but it needs certain conditions, support and understanding for that to happen.  Maternity services in the UK are at breaking point: a rising birth rate and too few midwives (or cuts in services) means that women are not guaranteed one-to-one care in labour; women do not have time to build a relationship with a midwife that facilitates trust; hospitals have policies that are not conducive to physiological birth - but are conducive to intervention and time management; and midwives are not challenged on practise that is outdated and not evidence based (valsalva for one).

In my mind, there are a few issues that continue to confound and prevent change;

1. The demise of midwifery care outside of the NHS institution
2. The continued attack on women and midwives who choose to work with physiological birth
3. That we are no longer teaching our daughters to be feminists (a dirty word in modern society)

Take for example the Daily Mail article this week on women's experience of traumatic birth; then read the comments.  Women attacking women, men attacking women, women sharing very distressing experiences - and many comments indicating 'doctor knows best and women should be grateful' .

Birth is hard work; it is not perfect, sometimes it is not 'beautiful', sometimes it is down right mean; that is birth.  This is NOT however the 'care' that may be inflicted, the unkindness of medical staff or the paternalistic attitude of doctors.  What women want is a positive experience of birth - however that birth may unfold, and having a midwife by your side who understands, supports and believes in birth and whom the woman knows and trusts can make a huge difference to that experience.  That is not too much to ask.

Birth Works - but we have forgotten this.  Instead, we focus on the 'what if's', how to 'manage' birth, how to 'save' women from pain; we have lost trust in birth and have made hospitals and the NHS the saving grace of birth - as opposed to utilising it as and when is necessary - ensuring resources and first rate care are available for women who need it (I for one have been grateful for their expertise when women in my care have needed it).  We have also de-skilled midwives and on a global level we continue to allow midwifery to be quashed, undermined, de-valued and not recognised for the amazing profession it is.  Midwifery and women are controlled -  Freedom for Birth highlighted some of these issues.

Independent Midwifery has enabled me to hone and develop my skills in physiological birth; I already had the belief and passion for normal birth, but had to work very hard in my NHS training to fully experience it.  As an IM, I want to share my passion, my knowledge, my skills (and I still have much to learn and hopefully will never stop learning) - but come October my right to work as an IM will be outlawed - another blog to follow on that.  For now, I shall continue to work outside of the NHS, I shall continue to support physiological birth at every opportunity, and I will aim to inspire my own daughters to be proud to be a feminist.

Birth Works; Women Work; Midwifery Works.

angela xx