Taking care of yourself in the early days with a new baby

As I sit here writing this blog, I am surrounded by paraphernalia in preparation for ‘The Baby Show’ where we are exhibiting over the next few days. One of the reasons we chose to do this (aside from marketing our brilliant postnatal packages), is that we wanted to reach more expectant parents to try and help them understand and plan for the huge transition that will occur once the baby has arrived, and to encourage them to really think about what to expect in the early days! Having a new baby is just about one of the hardest thing you will ever do; caring for a baby 24/7, recovering from childbirth and dealing with lack of sleep often adds up to an intense and sometimes overwhelming period of time.  At The Baby Show, we have been invited to speak each day about taking care of yourself in the early days, and these are our top 5 tips that we will be sharing:

Delegate household chores BEFORE you have the baby. Arrange a cleaner, organise on-line food groceries, book a dog-walker. Think about what you can get someone else to do so you don’t have to.

Sit comfortably: cesarean or perineal stitches can be sore and tender after the birth of a baby. Trying using incontinence knickers in the first few days. Much more comfy than thick maternity pads and sit high over the cesarean scar.

Sleep, rest, sleep and rest a little more. You’ll be told this a lot.  But it makes a huge difference to long term recovery if you make sure you rest.  You can save being ‘super mum’ for a later date.

Take your time: recovering from childbirth and understanding your new baby doesn’t need to be rushed.  It takes around 4-6 weeks to physically recover and learn the skill of breastfeeding.

Eat well: feeding a baby makes you supre hungry (you’ll need an extra 500 calories a day).  Fill your fresser with pre-made food and have plenty of nutritious snacks on hand, such as dates, apples, cheese, vegetable crisps and hummus. Try making these ‘goodness flapjacks’ – you’ll love them!


If you’re heading to the baby show, come and visit us at stand D5.  We look forward to seeing you!

The Pregnant Midwife – the second trimester

I am now well into my third trimester and so this blog is a little late in coming; time is going so fast at the moment. I was very glad to start feeling better by around 15 weeks pregnant, just in time for a 2 week holiday camping in the South of France (that’s me relaxing there above), which in hindsight would have been a nightmare if the nausea had continued! The only real symptom I still retained was needing to wee at all hours of the night, and so, worried about the middle-of-the-night walk to the toilet block I purchased a ‘she-wee‘. . . in the end I became good at timing my last drink of the day so it was barely used, but what a great invention for such a situation!!

The rest of the second trimester has zoomed by and, I am happy to say, been fairly uneventful. I took up pregnancy yoga when I returned from holiday, and met some new friends locally who I am sure will become great sources of support when we all have our babies in the next couple of months. As a midwife, I’ve seen how important support is in those first weeks and months with a new baby, which is not as easy to come by now that most people live some distance from their families. In the past couple of years we have cared for some Indian families who have very definite cultural traditions around supporting the new mother and family: many will be looked after for a period of 40 days, with all of their meals freshly prepared, cleaning and washing completed and little else to do but focus on recovery and feeding their new arrival. While I am not sure having my parents living in our two-bed flat for 40 days would be that agreeable to either party (love you mum and dad!), I have seen the effect that such a level of support can have on a woman’s recovery. There is so much focus now on ‘bouncing back’ after child birth; even if you (or I!) have a caesarean section (ie. major abdominal surgery) we will be encouraged to be on our feet and moving around within hours after the procedure. I have read a number of articles recently talking about how important it is that women get out of the house in the days following birth, but I do sometimes wonder whether this pressure to be back to normal so quickly has the opposite effect than is intended. No matter how we give birth, the body and mind take time to recover and adjust. We often offer a gentle warning to our clients planning a home birth to remember that this recovery process still needs to take place, and to take time to rest and re-cooperate in the days following birth, however ‘easy’ their birth may have been. Hopefully in a few weeks time this will be advice that I will remember for myself!

Something I have been asked a number of times during the second trimester and beyond has been whether I am nervous about giving birth, given all of things I will have seen both during my training and as a qualified midwife. In my role as an independent midwife, I am lucky that most of the births I support are calm and empowering experiences for the labouring woman and her family, and I am truly grateful that I became a midwife before embarking on pregnancy and motherhood myself. But even when things do not go exactly to plan, the difference between a traumatic experience and one which does not leave lasting effects on the mother and the bond with her new baby seems to be about choice and control. A woman who is still able to make choices about how she births her baby, even if she needs a level of intervention like an epidural or a caesarean section, can still have an empowering and positive experience. This could be as simple as wanting to mobilise near the bed once an epidural has been sited, or to be in all fours on the bed rather than on the back (most epidurals are ‘low-dose’ now, allowing for full range of movement), or requesting skin-to-skin contact with baby immediately following a caesarean section. In the case of any intervention being offered, there is usually always time (unless it is a serious emergency requiring a fast response) to ask for 5 minutes to discuss options with a partner, doula or other supporting person. There are many people out there (including some midwives) who believe that birth plans are pointless given the unpredictable nature of birth, but there will always be elements of our care which we can still have a say in, even in the most difficult births. For this reason my husband and I will absolutely be making a birth plan with our wonderful midwife Angela (had to get a mention in there somewhere..!), and I would encourage anyone else out there to do the same, even if it is just a short bulleted list of the things that are most important to you and your partner.

My apologies that this blog hasn’t been very second trimester-specific, but I am personally very glad not to have had to write about ways to alleviate all of the terrible symptoms I have been having – let’s see if I can keep it up for the next installment! :)

Tami x

The Pregnant Midwife – the first trimester

When I started my midwifery training, I remember our tutor going around the class and having us introduce ourselves. Each person said a little about why they came into midwifery – and several of my colleagues (and later friends) talked passionately about their own birth experiences, good or bad, which led them to exploring midwifery as a career. I remember feeling that the mums in the group already had such a head start on the rest of us – and that I would always be a bit ‘lacking’ as a midwife until I had actually been through pregnancy and birthed a baby myself. As I progressed through my training and became a more confident student and then a qualified midwife, this feeling never entirely left me, and the question from pregnant and labouring women would often be asked: ‘do you have children yourself?’. So, when my husband and I found out that I was pregnant back in February this year I was very pleased to be finally adding the accolade of ‘mother’ to my CV!

In those very early weeks before any real pregnancy symptoms appeared, I honestly felt that as a midwife I was entirely prepared for the first trimester of pregnancy. I knew it was likely to be tough, and I had some trepidation about nausea and sickness (particularly as my sister had hyperemesis throughout both of her pregnancies) – but I assumed that my midwifery experience would at least mean that nothing the first trimester could throw at me would take me by surprise. And of course, as you’ve probably already guessed – it did! Completely! The nausea was constant and severe from 6 weeks of pregnancy, and I also started experiencing debilitating migraines which I had never had before being pregnant. There were many days when my husband came home from work to find me in the same position he had left me that morning. During this period, as I’m sure all pregnant women do, I tried absolutely EVERYTHING to try and find some relief (see photo above for just a small selection of my remedies!). Some things worked for me and some things didn’t, but one thing that did work wonders for me was magnesium…


Angela and I have long known the benefits of supplementing with magnesium in pregnancy, and often recommend Epsom salts baths to our clients. The majority of the population (pregnant or not) are deficient in magnesium, and in pregnancy our bodies find it even more difficult to absorb this mineral. I had assumed that as I was taking a wholefood pregnancy vitamin containing magnesium that this couldn’t be my problem, but after speaking to a very knowledgable midwifery colleague I learnt that our bodies can’t absorb magnesium in tablet format. So, I purchased some dissolvable powdered magnesium (I used Mag365 and bought it from Amazon for speed of delivery – I was desperate!) and started taking it that evening after 3 days of severe headaches. Within 24 hours I was completely headache-free! Magnesium deficiency can cause all sorts of symptoms in pregnancy, including headaches, insomnia, cramp and oedema (swelling) and so taking a supplement such as this, massaging magnesium oil into the skin or soaking in regular Epsom salts baths can bring much relief to pregnant women.


Despite having a very good diet pre-pregnancy (little sugar, no wheat, lots of vegetables, no processed foods etc) I found that to get through the first trimester I was eating everything I knew to be terrible for me! White bread, sugar in all forms from jelly tots to snickers bars to ice cream, lots of cheese and dairy and very little else. Nutrition is something I am very interested in and which we spend a lot of time discussing with our clients, and I was quite ashamed of the contents of my food cupboard and fridge for many weeks. However – I truly believe that you do whatever you can to survive those first few weeks, and that feeling guilty about it isn’t helpful at all. I had said this to clients having rough first trimesters in the past, but it is only now that I truly understand the reality! Now that I am feeling less nauseous I will be taking some of my own advice and incorporating protein into all of my meals and snacks, and cutting back on the sugar. Interestingly I already feel less inclined towards sugary things, it is amazing how our bodies tell us what is best for them if we listen hard enough.

My final thought on the first trimester would be to apologise to any clients who I haven’t been as sympathetic to as I should have been! The terms ‘morning sickness’ and ‘tiredness’ are so common when discussing the first trimester that it is easy to underestimate the impact they have on your daily life. I am just now starting to feel a bit more like a normal human being and hoping that the blooming will happen very soon!

Tami x

New website launch!

We are super excited about today’s launch of the new North Surrey Midwives website, logo and branding! Huge thanks to the families you will see featured who have allowed us to use some beautiful photos of them and their bumps/babies/births to provide a taste of what we do. A great team is behind this site – including my very talented graphic designer sister Hannah, our brilliant developer Kris and our lovely photographer who helped put all of our clients at ease during our ‘photoshoot’. We are hoping to use the website to do some additional promotion of our postnatal services which we feel most families would benefit from – so if you know anyone who is having a baby soon and would like some extra care and support with their new arrival then direct them to us! If you have any feedback on the website we would love to hear it, so please do get in touch.

And we’ll be blogging a bit more regularly from now on so please do come back to the blog one day!

Tami x

A week in the life

This week has been a very special week for me as an IM, and I was very honoured and privileged to receive third place in the BJM Community Midwife of the Year awards.

It was a spectacular evening hosted by the British Journal of Midwifery and a real highlight in the midwifery year; a time when midwives from all arenas can be acknowledged for all the hard work they do – and a wonderful opportunity to wash of the placenta and booby milk, get dressed up, and let our hair down!

Being an independent midwife is hard work; there is an awful lot that goes on behind the scenes and being on call 24/7 is not always easy.  It is however incredibly rewarding, and after heading up to collect my certificate on Monday night, I was reminded of some of the really hard times over the past few years when IMUK worked hard to retain independent midwifery and the right for women to choose.  During that time, I made a ‘Week in the Life’ video to use at an IMUK open day to highlight the work we do and the way we do it.  I am really pleased to share this video with you now:

I love being a midwife (mostly) and do feel very privileged to work in this way.  I am not sure that being on-call will be right for me forever, and I do grow weary of it at times.  However, I think that probably applies to many of the different midwifery avenues that are out there: any job that gives of yourself can lead to burn out and fatigue – which is why it is so important that we look after ourselves – and are looked after (Jeremy Hunt take note).

So thank you BJM for my award, thank you women for sharing your lives with me, and thank you to everyone who supported the campaign to save IM’s and kept us going!

Angela x

The Midwife’s Bookshelf: Waterbirth

Currently on my bedside table: Waterbirth by Milli Hill

Most hospitals now offer water immersion and waterbirth as an option for women. The hospital I trained at even has one available for women to use on its consultant-led labour ward (although I have to say that I hope it is being used more now than it was when I was a student…!). Waterbirth was introduced to the UK in the 1980s, and we have learnt more and more about the benefits of labouring and giving birth in water since then. I am currently reading Milli Hill’s new book on the subject, which is an absolute delight to read whether you are a midwife or a pregnant woman considering the use of water in labour. It is made up of stories, many from women who birthed their babies in water, but it also includes some other perspectives: an interesting one for me was a 13-year-old describing her experience of being present at the home waterbirth of her baby sister. All of the stories convey a sense of the birth pool as being a ‘protected space’ – a place where the labouring woman is completely in control of her own body and experience.

Article of the week:  Raising a quizzical eyebrow: the language of birth by Kathryn Kelly (Essentially MIDIRS, March 2015)

Not directly about waterbirth – but a very thought-provoking piece on the use of language in Essentially MIDIRS this month. The article identifies some common phrases and terms used by midwives and doctors which can affect the relationship between birth professional and pregnant/labouring woman – and in particular can subtly undermine a woman’s belief in her own body. Seemingly innocent words such as ‘allow’ (“am I allowed to get in the pool yet?”) , ‘need’ (“she needs an epidural”) and ‘just’ (“I’m just going to break your waters”) take control away from women and reinforce professional hegemony. I strive to ensure that the language I use is supportive and not authoritarian, but this article is a little reminder to be aware of the power of the words we choose.

From my personal library:  Evidence and Skills for Normal Labour and Birth by Denis Walsh

This book is a must-have for any student or midwife. During my midwifery training, it gave me enough confidence to question certain practices which I knew to be non-evidence based and encouraged me to always question why something is (or isn’t) being done. Denis Walsh looks at the available research on everything from place of birth and fetal heart monitoring to second stage rituals and care of the perineum. The evidence on each topic is discussed and appraised in simple terms which would make it easy for a layperson to understand – although it is aimed at midwives, I have lent this book to a few pregnant friends who have found it invaluable. The book includes a chapter on water immersion and waterbirth, and Walsh covers the therapeutic, physiological and psychosocial benefits of waterbirth before moving on to some very practical recommendations for practice.

Tami x

Sharing the Skills: The Pinard

I have two expectations when a student comes to spend some time with me:

1. That they have read Ina May
2. That they are prepared to learn how to use a Pinard (if they are not already practised)

When we think of all the technological advancements that have been made in pregnancy and childbirth, it is often assumed that the beautiful Pinard Trumpet is better placed way back in the ‘olden times’, but this little piece of midwifery equipment is (and should be) a staple part of midwifery practise – where-ever that is taking place.

Firstly, lets look at what National Guidance says about the Pinard: intermittent auscultation is the national recommendation for the ‘low-risk’ (that’s another blog in itself) woman in labour.  In these guidelines it recommends the use of a Pinard or a doppler (sonic-aid).  It also states that when there is a concern with a low base-rate foetal heart on continuous monitoring, it is important to ascertain that it is not the maternal heart that is being recorded.  The Pinard isessential in that clinical scenario is you can not pick-up the maternal hear beat when using one.  So, the expectation is that a midwife should know how to use a Pinard.

Secondly, let us think about the routine use of a doppler (sonic-aid) to auscultate the baby’s heart rate.  The little sonic-aid is a wondrous invention; it enables midwives to hear that rhythmical heart rate, reassuring that all is well, and enables parents to hear their baby’s heart from very early in pregnancy.  I always find it completely heart-melting the first time parents hear that sound and they are full of bare emotion.  BUT, when we use a doppler, we send a high-wave frequency through the uterus that resonates with the baby (again, that’s another blog post).  Although National Guidance no longer recommends routine auscultation at an antenatal appointment, many mothers find this a reassuring and exciting element of their care.

Around 2 years ago, as I reflected on my birth statistics, I realised that I had a relatively high number of ‘compound presentation’ births (this is where the baby is born with it’s hands’ up by its head).  Whilst this is not usually a problem, it can sometimes make birth a little longer or potentially cause more perineal trauma for mum.  I pondered on this for a while, and recalled a very wise, older midwife once saying that she felt we had more compound presentations since the introduction of routine sonic-aid use, and perhaps the baby’s were “‘covering their ears from the high frequency sound”.  So I started my own little trial and I no longer use the sonic-aid in the last trimester or pregnancy: instead I show the women my little Pinard (they love it!) and use a foetoscope (see picture) so that they too can listen to their baby.  And yes, in that time I have had NO babies with hands up by their heads.  Maybe a coincidence?  But one I am not tempted to test!

How to use a Pinard
You can only really use a Pinard or fetoscope successfully from around 28 weeks of pregnancy – before this the baby is just too small and you have to place the Pinard directly over the baby’s heart or shoulder, so you need to be able to palpate where the baby is lying.  Antenatally, its relatively easy to use once you’ve become skilled at palpation and ‘listening’, so as a student midwife this is the best time to hone your skills!  It is usually easier to start with a plastic Pinard and progress to a wooden one.  The ARM sell beautiful beech Pinards.

Using a pinard in labour can however be a little trickier -especially if the woman is planning to use water in labour. The expectation will be for the woman to lift her bump in and out of the water which can be very disruptive to the flow of her labour!  A water-proof sonic aid is a God-send as you can easily monitor her baby’s well-being and work around her by reaching down into the pool and under her bump as unobtrusively as possible.

Sara Wickham has written a lovely explanation on how to use a Pinard (saves me re-writing it!) and Kay Hardie, from Kent Independent Midwives has made an excellent you-tube video on how to use a Pinard.  Read and watch to learn – and then practice, practice practice until you are confident and able to use one!

The Pinard Trumpet may be an ‘old fashioned’ peice of equipment, but its place is just as relevant in 21st century midwifery as it ever was.  What do you think?

Reflections: Postnatal care

So first things first, I am not Angela! I am Angela’s practice partner, Tami, and I joined North Surrey Midwives last year as an independent midwife. It’s been a year now since I spent a week living and working with Angela and getting to know what being an independent midwife (IM) was all about, and this seems like a good time to reflect on everything I have learnt during that time. I’ve tried to write this blog a few times now though and it seems I’ve already learnt enough to fill a book (a project for the future perhaps!?) so I am going to focus my first post on postnatal care. This may seem like a strange choice; I mean, I attended few home births during my midwifery training and have attended many more during this first year of independent practice, surely I should want to write about that! Well, I do. But interestingly, I have found that the biggest learning curve for me has been caring for my independent clients in the first 28 days after their baby is born.

Working within the NHS setting on a community team, we saw most women three times postnatally: the first visit the day after they returned home from hospital (so usually day 1 or 2 for most women), the second visit on day 5 when we would do the bloodspot screening test, and finally a visit on day 10 to discharge the woman and her baby to the care of the health visitor. I never thought much of the fact that we didn’t routinely see women on day 3 or 4, despite knowing that these days are often the most difficult for new mothers.

A woman’s milk usually ‘comes in’ around day 3, sometimes causing engorgement and her temperature to go up a bit, and it is around this time that the ‘baby blues’ can take hold. The first few days with a new baby are a bit of a whirl wind, and day 3 can be (this isn’t always the case of course) the day that exhaustion really hits you – loving care, support and reassurance are vital during these days. It wasn’t until I became an IM that I really saw all of this though – and learnt how vital postnatal care really is. I saw changes in my usually strong, outgoing clients – they were suddenly uncertain about following their instincts as they had done antenatally and during their labours.

At first I felt like I should have some intelligent solutions for them, something they could do or take to relieve the exhaustion and anxiety they might be feeling. But I soon came to realise that the most important thing is being able to talk about these feelings and be reassured that they are entirely normal at this stage after having a baby. Whether this is the first baby or the fourth, having someone come over for a cup of tea (but don’t worry we make our own!!) and a good chat about everything you are feeling during those first few days really can and does make a difference. When I initially met and worked with Angela, I remember being a bit shocked at her telling a client whose new baby was cluster-feeding every evening (ie. feeding more frequently than usual) to put a box-set on, put her feet up and have a glass of wine and settle in for the evening with her baby skin-to-skin. What was she doing – promoting wine while breastfeeding!?! Well, I visited the same woman with Angela a few days later and the change in her was immediately apparent: reassured that this behaviour was normal for her baby and then having a plan to cope with it (plus a little stress relief via the wine) made all the difference for her. And I have given that advice a few times myself now with similar effects!

One of the biggest learning curves when making the move from an NHS setting to independent midwifery has been not relying on hospital protocols to guide practice, but instead using the best evidence, collective wisdom of the very experienced midwives I work with, parent’s intuition and the full clinical picture to make decisions about care provided. For me, I have felt this difference most in the postnatal period, and particularly around expected weight gain of the newborn. Most hospital policies state that a baby who has lost more than 10% of her birth weight at day 5 should be transferred back into hospital for further checks. But is this really the best course of action for a baby that appears clinically well in every other sense (plenty of wet and dirty nappies, pink, active, alert, waking for feeds and perfectly latched when breastfeeding) and a mum with an absolute fear of hospitals? Transferring mum and baby into hospital in this case could potentially make the problem worse: mum will be anxious which will affect her milk supply, and baby may undergo invasive tests which could disrupt breastfeeding. In this case, lots of skin to skin contact and intensive support with breastfeeding and expressing, while keeping a close eye on the baby in the following days meant that mum and baby could stay at home and the baby quickly began to put weight on. For this baby, it was ‘normal’ to lose a bit more weight than usual in the first few days of life. For another baby it might not be – and this is the challenge of independent practice compared to working from guidelines.

Although I didn’t expect postnatal care to be an area in which I still had so much to learn, I have really enjoyed gaining all of this amazing knowledge from both the mums and babies I have cared for, and the midwives I have worked with over the past year. Midwifery is a career in which you are continually learning, and so I am sure this is just the beginning!

Tami x

Sharing the Skills: Supporting birth without the use of vaginal examinations

I have struggled to write this particular post for the past week or so; do I reference, don’t I reference. Am I trying to be the ‘expert’?  Is this formal, informal.  Argh – round and round I go!  Until a colleague reminded me this is a BLOG post, meaning it’s an informal piece of my opinion (see disclaimer thingy) and breathe……..

I can still remember the first Vaginal Examination (VE) I performed as a student midwife.  I remember two things mainly:

1. I had no idea what on earth I was feeling!
2. That this was a very invasive procedure

Many units have a 4-hour guideline for VEs to assess the progress of labour; this routine assessment has no real evidence to support it and is still of unproven value in routine midwifery care, despite being recommended by NICE (it is important to acknowledge, that NICE states women should beoffered a VE).  VE’s can be a very helpful tool in understanding a labour when perhaps midwifery intervention may support the woman in keeping her labour normal, when clarity around labour progress is appropriate, and / or if it will affect the plan of care.  When used as the marker for progress in labour only, VEs can cloud the midwives understanding of what is happening in the woman’s birth story and cause the woman to doubt her own body.

The art of Midwifery is the ‘big picture’, and it is through many different signs that a midwife may recognise where a woman is in her labour.  This awareness is not ‘taught’, but learnt: learnt from the women as you observe undisturbed birth, learnt from sitting and quietly absorbing the behaviours unfolding in front of you, and learnt from not starting from a place of ‘knowing best’.  As a result of this, the thoughts below are not a ‘check list’ of progress in labour, simply prompts to help you consider the physiology of what may be unfolding before you.  Remember also that all women are different, and every woman and birth can unfold in a way that is unique for them.

Let us consider then, alternative ways of recognising a labour that is progressing:

How low can you go?
When I was a student midwife, I heard the wonderful Jane Evans speak on Breech birth.  In her talk, she described how women get ‘closer the the ground’ as their labour progressed.  In labour, as those powerful surges increase in intensity, the woman finds it harder to be upright and conserves her energy by moving into positions that bring her down – usually into the all fours, or leaning over a sofa etc.  As a guide, the closer she is to the ground and needs to stay ‘grounded’, the further along in her labour she is likely to be.

Those wonderful noises
Experienced midwives can often tell where a women is in a labour from those lovely noises she omits; Liz Nightingale wrote an excellent article in Midirs on noises in labour which is well worth getting your hands on. Women, under the influence of Oxytocin in labour, start to withdraw into themselves.  Talking and conversation dwindles (and so too should birth workers!), but the woman will naturally start to moan and groan through those surges; those noises come from deep within her and she has little control over them.

The ‘purple’ line
If you google this term you will find lots of excellent blogs reflecting on this phenomena, pictures on what you may see and so forth.  My favourite post is inBirth Without Fear which is beautifully written: just read that for a great explanation on the purple line.  I love the purple line; once you recognise it you can’t fail to notice it.  Just wish bottoms came with a little gauge – you know, when it’s this height the cervix is x-cms etc!

Sense of humour failure
When the woman is no longer smiling, then we are in serious business (except for those women who are having serene, orgasmic births – they smile a lot).  Humour can really help a woman in labour as it can ease tension.  If you follow her guide however, the more serious she becomes the less she may appreciate wise-crack jokes from her supporters, and the more likely her labour is advancing well.

It’s all a bit sticky down here
Around 8-9 cms, women will discharge a sticky, blood-stained mucousy plug as the cervix really opens. Yay!  Even better still, as the cervix becomes fully open, the waters will spontaneously release if they have not done so already.  There is NO NEED to do an ARM if a women is 9 cms and membranes are intact (and yes I have seen midwives do this, because otherwise how will the baby get out?).

Cold Feet
As the uterus continues to work beautifully, the blood circulation will move more and more towards to uterus: this is why women get cold feet as labour progresses.  A German midwife (when I was a student) also taught me that the heat will move ‘up the woman’s’ legs.  At around 5 cms, the heat will start from just above her knees, 8 cms the thighs feel cold, at 9cms, only a small amount of heat is left at the top of her thighs.  We used to have guessing games by gently placing a hand on the woman’s thighs to see ‘where she was’.  It doesn’t always work, but is gentle and non-invasive.  Use the back of your hand to gently asses the coolness of the legs.

Pushing on through
Why, oh why, oh why on earth do some midwives feel the need to ‘confirm’ the onset of second stage with a VE?  Really?  As a woman moves into second stage, she will start to make grunting / expulsive noises.  These will intensify as the baby moves further down, triggering further expulsive urges.  The woman’s body will start to ‘open’ as the rhombus lifts.  The purple line will be highly visible and prominent.  She will probably poop.  All of this will happen either quickly (as with the foetal ejection reflex), or for the vast majority of women, s-l-o-w-l-y!  Women can tell when they are ‘moving’ their baby and will often remark they can feel the baby moving down.  If after a period of time of strong expulsive urges, there are no external signs of descent, then a VE may be appropriate.  That time depends on the whole clinical picture.  And no, 10 minutes is not long enough.

There are many other ways of recognising progress in labour without the use of VEs (and please do share them); these are the ones I use to help me recognise that labour is progressing without needing me to ‘do’ anything other then keep the mother and baby safe and hold the space for the birth.  Observing the woman in a non-invasive way (i.e. not staring at her and‘drinking tea intelligently‘) normally enables the midwife to sense if something is not ‘quite’ right and provide the appropriate care to help the mother birth her baby as she needs to.  And this is usually herself.

Angela x

New Year Pop

A few months ago, a little add popped up on my computer.  I clicked it away without a thought.  A little later it popped up again; again, I clicked it away, thinking nothing of it other than it ‘being annoying’.  A few days later, sure enough the advert appeared again…. and again…. and again.  I ‘quickly’ clicked them away and carried on with my work.  Slowly, over time, these adverts became a regular part of my day, and I stopped really thinking about them.  Just methodically removed them and carried on with my tasks: pop – click – pop – click – pop – click (getting the picture).  (If you are wondering what this has to do with midwifery – bear with me, it will make sense.)

Two weeks ago, my computer needed an overhaul; those annoying little ads had grown so much, that I could no longer log on to my blog (hence no posts for a while), I could not move on the internet without being directed to sites I did not wish to visit  (er, no I do not need Viagra thank you) and my working time at the computer ground to a halt.

Reflecting on this (and here is the midwifery link) made me think about how small interventions in midwifery practise have become a routine part of our care.  Let’s take the vaginal examination (VE) for example; these are now soroutine that we no longer even see them as an intervention, and yet, they can interfere so much in a woman’s birth that they can slow and grind a labour down to a halt (see what I did there?).

As midwives, we are considered ‘autonomous practitioners’; this means that we work to evidence base and to the woman’s needs.  There is no evidence to support routine vaginal examinations and whilst they can help understand the progress in labour, most women find them invasive and unpleasant.  Encouraging the woman to ‘pop’ onto the bed, the ‘quick’ VE, the repeat of this process at routine intervals, in my opinion, slowly interferes with the midwives care and her understanding of ‘normal’ progress in labour, and most significantly affects the woman’s trust in her body, until eventually the labour grinds to a halt and needs an overhaul (or caesarean) – just like my computer.

This year I have been blessed to attend 15 women in labour: only 6 of those women required a VE to support plans around their labour and birth.  I promised to ‘share the skills’ previously, but the problems with my computer jaded my work, distracted me from writing and prevented me for being ‘with computer’.  Yet it took a real crisis before I addressed and faced up to the problem: it was just easier to keep pushing the problem away.  Sound familiar?

2013 has been a year of facing up to a huge problem: the demise of Independent Midwifery.  Over the past 12 months, I have been involved in the odious task of campaigning to save IMs, to save my livelihood, to save choice for women and to save a group of midwives who believe in true autonomy.  It was a problem I did not want to face up to: it is a problem that many midwives are not facing up to, and it is a problem that the Government does not wish to face (I think they hope we will all  just go away).

If midwifery is to remain a strong profession, then we need midwives to have the choice to work independently.  As we enter 2014, I feel optimistic and positive that this year will herald a change for Midwifery and that midwives will reclaim their profession.  I feel confident that I will be able to continue to practise in a way that supports women without the routine use of interventions, and that working in this way will not ‘grind to a halt’.  And mostly, I look forward to not campaigning anymore – but rather to getting back to what I love most.  Being ‘With Woman’.

What will your 2014 pop-up for you?

Angela x