The Midwife's Bookshelf: Blessings

Current read on my bedside table: Blessing the Way

Ok, hands up - I hate baby showers.  Yes it's all very nice receiving gifts for the baby, but it feels like the nurture for the mother gets lost somehow.  My friend Keeley is a celebrant and we work together to bring my clients who choose one a 'blessing way'.  This beautiful ceremony puts the mother in the centre of the circle of women who come to share their love and support for the 'right of passage' that is to unfold.  This beautiful little book by Janie Rose (a gift from Keeley) celebrates the journey from pregnancy to mother-hood with wonderful verse and illustration.  I love it.



Related reading: if you wish to learn more about creating blessingways, this wonderful book from The Mother Magazine will help you. 

Article of the Week: Meg Taylor, Midwifery Matters (ARM) Autumn 2013

There are occasionally midwives who inspire you to think about midwifery on a very deep level; Meg Taylor was one of those.  This dedication to Meg (who died earlier this year) from her friend and Independent Midwife Elke is moving and beautiful; and alongside it are some of the wise words the Meg shared on the UK midwifery list.  You can also read her writings here.

If you do not subscribe to ARM and the journal Midwifery Matters then perhaps it's now time you did; always interesting, always sharing and always inspiring.

From my personal library : The midwife's labour and birth handbook, Chapman

Being a midwife is a blessing; but there is a lot to learn (and keep learning) in our journey to support women.  This book is a welcome text alongside the likes of the larger 'recommended texts' in midwifery training.  It has a softer, warmer approach to clinical care and provides ideas and thoughts on midwifery knowledge.  As a practising midwife, whenever I am reflecting on an episode of care, or reading around a topic I am thinking about, I use this title to extend my thinking.

What will you add to your midwifery collection?

Sharing the knowledge: let us begin.

Midwifery is one of those professions where you develop your skills over time; always learning, always discovering something new, remembering something forgotten, and gleaning knowledge from many sources.

To qualify as a midwife in the UK, you undertake a 3 year full-time course, with a roughly 50% split of theory and practice (practice taking place within the NHS).  You learn drills, you read books, write essays, 'deliver' babies, watch caesarean sections, 'help' women to breastfeed and 'learn' the day-to-day skills of midwifery in the NHS.  This is normally under the watchful eye of a mentor, an experienced midwife who guides you along the way (assuming of course there is not a huge theory-practice gap with what that mentor is teaching you).

Throughout my 3 years as a student I learnt huge amounts, but (as with most professions) many of the skills I have learnt have come with the experience of serving women in childbirth, watching women labour in their own environment without the time constraints of unit policies, and learning to trust even more that the less I 'do', the better the outcome*.  Much of this knowledge was not 'taught' in my training and I believe there is such a strong culture of fear around childbirth, that we tie ourselves up in knots to address unit policies, many of which are not based on the evidence.

So how do we share and spread that innate midwifery knowledge that respects women and the natural process of childbirth, when the practice we are exposed to within the training may (or may not) often sit within the medical mode of childbirth.  How do we give student midwives and newly qualified midwives a glimpse into a different way of approaching birth?  I believe we need to be writing about it, shouting about it, talking about it, and sharing, sharing, sharing.  Of course, this then exposes us to the risk or being 'ridiculed', or worse, intensively scrutinised in our practice; this then moves this innate knowledge back into the 'secret' side of midwifery, and does not enable policies (such as arbitrary time limits in the 2nd stage of labour) to be challenged.

I am planning to 'put myself out there' a bit and start to write about skills and ideas, such as:

• confirming the onset of labour without vaginal examinations
• assessing labour progress without vaginal examinations
• auscultation using a Pinnards or fetoscope
• facilitating spontaneous 2nd stage without directing women on 'how' to push
• water birth
• physiological 3rd stage
• the effects of energy on the labouring woman
• assisting a woman with a mal-positioned baby

I invite questions or suggestions for topics, and I am inviting guest blogging midwives to share their knowledge too.  Along with this I also need to add in that 'disclaimer'; that is to say that I am not saying this is the only way to practice, or that it is always appropriate to the woman you are caring for, or that it will sit easily within the trust you may be working within.

I do hope you will enjoy these blogs, and and share and talk about skills with your colleagues, and ultimately develop your own practice in a way that keeps the woman and the process of normal birth central to your care.

Enjoy
angela x

*doing less is of course not to ignore a woman whose labour is changing and will perhaps require help in another way.

“Be the change that you wish to see in the world.”― Mahatma Gandhi

The Midwives Bookshelf

Current read on my bedside table: Childbirth and the Future of Homo sapiens. Odent

This is the latest effort from Odent, who was a strong influence in my understanding around hormones, physiology and the effect of those attending the woman before I even started my midwifery.   I am looking forward to exploring the 'future of humanity' and the significance that birth will play in this.

Article of the Week: Holy Meconium: a potted history.  Midirs, October 2103

In this last edition to be edited by the exiting MIDIRS team(!), this excellent article looks at the issue of Meconium Stained Liqour (MSL) and Meconium Aspiration.  The author examines the evidence (or lack of?) that underpins current thinking, provides challenging thoughts around policies for women with MSL in labour, and considers the issues for midwives in practice.  

A reflection on this article will be going into my PREP folder and on my list of topics to research further! 

From my personal library : Ina Mays Guide to Childbirth. Gaskin

If you have not already read any of Ina May's work then you need to make this a priority!  Spiritual Midwifery was my inspiration as a student midwife, and Ina Mays Guide to Childbirth has also become a firm favourite and a recommended read for all my clients (I have several copies I loan to to them) and students attending my workshops.

My favourite chapter is "Sphincter Law" and when I was priveledged enough to visit The Farm, Ina May ran a workshop on this whole topic.  For me, it is the strongest factor in the progress of labour and as Ina herself says "We obey Sphincter Law".


What will you add to your midwifery collection?

Shiney New Blog

I am so excited to feel my bloging fingers return to the keyboard, and am bursting with new ideas for midwifery and birth related posts!  It's been too long.....

I am planning to start 'what I have been reading' posts, sharing what's on my book shelves with you, as well as 'how to 'posts on midwifery skills (primarily aimed at students) and of course my usual reflections on current topics.

Speaking of which, we are in October.  October.... the impending end of Independent Midwifery as we know it.  Of course, as with all things in life, the goal posts have changed and the NMC confirmed this week that there is a delay in the implementation of the new legislation and we now have until February.  In the meantime, IMUK, who have been working incredibly hard over the summer months and have found a product that is a solution to the insurance fiasco, continues to beaver away at getting insurance in place long before that deadline (we very much hope that the dear DoH do their bit and help us on our way) .  You can keep up to date here.

Pretty knitted things

Exciting, turbulent, history changing times lay ahead; and it is down to the passionate and strong midwives and supporters that there is light at the end of the tunnel.  Women have always had a strong influence in the course of history; this year was the 100th anniversary of the death of Emily Davison, the suffragette who threw herself under a horse; I feel I am part of a modern suffragette movement (although I am not throwing myself under a horse), not one working to get the vote, but one to get a basic human right to know and choose your midwife as a normal part of the childbearing continuum.  I am a feminist - and rightly proud.  Okay, I am a knitting feminist, and rightly proud.  Okay, I am a knitting, mascara wearing, girl-who-likes-pretty things feminist, and rightly proud.

Mascara wearing midwife on a mission

Anyway world, watch out.  Or you may have a bunch of media wielding, modern suffragettes playing havoc with your his(her)story; and it might not be pretty or knitted.

angela x

Why I Campaign.....

Oh how I have missed blogging: I have so many ideas I want to share, so many thoughts I want to get down, so many words that need to be committed to the page.  I just don't have the time or space to do it at present..........

.....so instead, I recently made a 'vlog' - which I share with you now.  Hopefully this will help you see why blogging has had to slow for a bit; but hang in there with me - I will be back to blogging as soon as I can!

angela x

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

Independent Midwifery: Dispelling the Myths

"I bet your clients are really demanding?".  Sigh.  Nope, not usually.  In fact, I find the hardest bit of being an IM is dealing with such misconceptions and answering questions (from an NHS midwife) as that one.  I wrote previously about 'what we do', now however, it is time to dispel some myths about Independent Midwives (IM's):

IM's are Maverick and Risky
On the contrary; IM's have a large number of women who would be considered 'high risk' within the NHS and as such are seeking a midwife who will support them in their informed choices.  This means careful thought and planning, often involving a Supervisor of Midwives to help arrange the appropriate care.  It means being up-to-date with the latest research so that we can provide safe, effective practice.  There are risks to our job; but we work hard to keep these to a minimum whilst supporting women fully in their choices.

Women who use IM's are wealthy
Different women, from different backgrounds and with differing levels of personal income book with IM's.  Yes, I have had clients whose disposable income is enviable, however the vast majority of my clients have to work hard to find the money for my fees.  Or they simply can not find the money and then we try to work something out.  For most clients, their priority is to book with a midwife whom they know and trust  - and this often means making huge personal sacrifices.

IM's earn 'loads of money'
You can see that in the shiny 2005 Citroen Picasso I drive, and all the holidays I take - NOT!  Out of my fees I have to pay for my equipment, administration costs, petrol, training updates, tax, holiday 'pay' (being self-employed means when I am not working I am not earning), journal subscriptions,  etc etc.  IMs really do not earn huge sums - and we really do earn our money!  24-on call is not an 'easy' option and can take it's toll on family, friends and day-to-day life.

IM's Clients are demanding
If wanting to have one-to-one care with a midwife you know and trust, appointments in your own home, and feeling supported in your choices is considered 'demanding' then yep, my clients are very very demanding.  I do find however that this standard of care pays dividends in normal outcomes, high breastfeeding rates and family satisfaction.  And I always get tea and cake (hence my expanding waist line).  Women are really so demanding!

IM's don't want insurance
We do, we do, we do!  We just can't get it!  Honestly, every time you go to a birth, to hear the little voice on your shoulder saying 'this could be the one that costs your home' is not fun!  We do it because we can (not for much longer), we do it because we care, we do it because midwifery services should not be a 'one size fits all' option.  I do it for myself (terribly selfish), but knowing who I am going out to when I get called to a birth makes me feel like a safe practitioner.  Plus, I don't have to get to know the woman and her family, instead I can just offer my full attention and be 'with woman'.  It's fantastic.

Independent Midwifery is not for everyone, just as being a labour ward midwife, or a consultant midwife is not for everyone.  The important thing is that just as women should have choice, so too should midwives.  

There are many myths around Independent Midwifery and IM's, and the one that is most concerning is that is does not matter if we are no longer able to practice.  The demise of IMs will have catastrophic affects, and midwives within the NHS will find that their autonomy will be significantly threatened - the RCM know this and just continue to play footise with a government that is calling the shots.   Just look to countries where midwifery has been persecuted in this way, and then see how many midwives there are.  It is worrying.

Independent Midwifery must survive - and you can help.  You can share this blog with everyone and anyone who has an interest in midwifery or birth.  You can tell people the TRUTH about IM's.  You can watch 'Home Delivery' on March 21st and see how we work.  You can join our facebook page and learn more.  Women matter - IM's do too.

angela xx