Life 'on-call' - making it work.

Recently, this question was posted on the IMUK Facebook page:

"I am really interested in the work/ life balance for family and relationships when on call all the time. How does it work?"

A really good question, and perhaps a concern that prevents people from working as an IM (insurance issues aside).  So this blog is for all you midwives, student midwives and aspiring midwives about the reality of life on-call and how midwives (IMs, NHS case-loading midwives, commissioned groups of midwives) find it not only workable, but balanced, rewarding, and fulfilling.

I have worked on call since October 2007; I have taken periods off, I've had periods where I have been on my knees, I have missed some family birthdays, I have even missed a family break.  There have been times I have totally resented it (and even tried to side-step for a bit), however the freedom to manage my working life, the autonomy I have as a midwife, the joy of seeing a family grow as you support the mother and empower her, outweighs the days when being 'on-call' can feel too much.

Working Hours
Developing my own self-imposed 'working times' was one of the first things I had to learn: initially I didn't do this as I was just so excited to provide the care I was offering.  What I quickly learnt was that not having my own 'boundaries' made me tired and resentful.  So now, I never work Sundays unless I am at a birth or it is early postnatal days; Sundays is family day, TV day, reading day; I won't answer texts (unless urgent) or check facebook / emails or make routine appointments.  I stipulate this to clients at booking and I have found that most women fully respect this.  My working 'hours' are 8am - 8pm, and only women in labour or urgent issues get my attention.  I home educate so most of my appointments are late in the afternoon so I can be there for my family.

Switching-Off
This is a real skill that takes time to develop; early in my IM career if a woman was 'imminent', getting to sleep was a problem.  What I have learnt in my time on-call is interesting; if I have not been called by 10pm, then I am very unlikely to be called out in the middle of the night.  I may get an early morning call, or a late evening call, but, in almost 6 years and caring for over 50 women, I have only been called out in the middle of the night a few times.  So if I go to bed without a call, I feel quite confident that I will get a full-nights sleep.

I have also learnt to tell women the days that are really inconvenient to me.... always spoken light-heartedly and with a smile, but since doing this women seem less likely to birth on those days.  I put it down the Oxytocin Factor - if they are worried about me not being there they release adrenaline and don't labour!  I only do this for really important things, like family birthdays and so forth - and of course I will be there if the baby decides otherwise anyway!

Having a Social Life
This was something else I struggled with; frightened to make commitments in case I got 'the call'.  Now, I just live life 'as usual'; I tend to drive myself places so I have the car if needed, women are asked to let me know if they think things are 'happening' so I can get home / sort my family/ make a decision about whether to go or not.  Generally, I will stay close-ish to home.  My family are really supportive and don't tend to mind too much if I can't make something; they do of-course have times when they feel the pressure of my work, but because there is so much time when I am available, around and participating, they get over it quickly.

Friends also know that sometimes I will cancel things last minute - but I guess knowing their friend is attending a birth must seem quite cool.  They certainly like to hear the birth story later!

Drinking is of course a bit of a no-no; turning up pissed to a birth might not be the safest way of practising.  I do have the occasional small glass of wine, and I like to make up for it when I am 'off-call'; personally I think my liver enjoys the time off.  And it saves me money.

The 'best-bits'
Supporting women and knowing what is important to them; not having to 'quickly' read notes and get to know the woman and her 'preferences'; practising 'hands-off' autonomous midwifery; managing my workload (choosing my hours outside of births); drinking tea and laughing with clients; continuity of care; taking my children to meet the new baby; wearing my own clothes (silly, but I hate tunics - so 'official'); being my own boss; lie-ins - no early shifts for me!; feeling proud of what I do; meeting fellow IM's and sharing stories and skills; meeting students - and learning from them as they do from me; having time with my family when I choose to; not waiting for the 'off-duty' to come out; catching babies with inquisitive assistants.......

The list is end-less.  Working this way is not always perfect, and there may be times in my life when working within the NHS will be the right thing at that time and having 'set' hours will be what I need.  Until that time, I will choose to work in this way - and fight to work in this way.

So I hope this answers the question for you - about what it's really like..... and maybe it might help you answer this question on survey monkey:

Would you work as a self-employed midwife?


angela xx

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 too.....as 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

It's in the words

Two weeks ago, I took my three home-educated children along to the Science Museum to enjoy The Human Body film on their IMAX screen.  The film was really interesting, with lots of amazing facts, clever imagery and clear explanation.

Then, we get to the 'birth bit'; I am an experienced 'TV birth' avoider now, having wasted too much energy shouting at rubbish programmes (OBEM is right up there in my list of hates), so I tried not to get too excited, so as not to be disappointed   That was the right decision, as four-hundred children of varying ages were presented with the typical birth scene I strongly feel should not be broadcast: the woman, on her back, full epidural, stirrups, a team of people (I think they edited out what was clearly an assisted birth), baby taken away, wrapped and returned to the proud mother.  And the icing on the cake..... the midwives phrase that makes me want to want to jump up and down like a raving bloody looney (and that is being tame on what I really want to say):

"come on, push, push, push, push, push,....

get ANGRY (with your baby?)".

Get Angry?  Angry....... so is what we're really saying, is that we want the woman to be this:

and then expect to her be this:

A diametrical concept to the extreme.

And it's not just here that the language of midwifery needs addressing;  how many times do we need to remind women and midwives that pizzas are delivered, shopping is delivered, parcels are delivered.  Babies are BORN. I do not deliver babies; I facilitate birth, I support, I catch, I guide.  I am in awe as a woman delivers her own baby.  Not me.

To empower women, we need to think carefully about the language we use: midwives are in a very powerful position.  Women listen to us, they value us, they (hopefully) respect us: what we say and how we say it sticks.  Let's look at some other examples:

"ohh.... that's a big baby your growing there."  ( Woman hears "oohh, I ain't ever gonna get this baby out of my vagina.")

"would you like some pain-relief?"   (Woman hears "midwife thinks I can't cope; better get some drugs before this gets worse")

"just pop up here on the bed, there's a good girl"   (Woman hears "I better stay here where I am told")

In a recent issue of the Midirs Essentials, there was an interactive section encouraging the reader to reflect on some of the common phrases used and often said to women;  I, even as a student, have never told a women to get angry, have never asked a women to "take a deep breath and push", and have always encouraged women to listen to their body.  I have seen students swiftly adopt these 'standard phrases', as if these mantras somehow make them a midwife, a part of the 'gang', or somehow more competent in their mentors eyes?

As a midwife, my aim and hope is to empower a woman to feel like this:

because, I believe, that only when she has released her inner-lioness, only when she has birthed her baby (in her own unique way), only when she has felt that she did it (even with an assisted birth), that she is the woman, the mother, the strong-one, can I expect her to be this:

Words are powerful.  Women should be central to that power.

The most common way people give up their power is by thinking they don’t have any. – Alice Walker.

angela x