Contraceptive advice from your Midwife in pregnancy.

(223 Posts)
missismac Sun 23-Feb-14 09:47:28

I'm just doing a project on this topic and struggling to get any info about womens views on this. I was wondering how you would feel about your Midwife raising the issue of postnatal contraception whilst you were still pregnant - say around your 36 week appointment? Is it something you would welcome, or do you feel maybe your head wouldn't be in the right place to take it in? Should it even be a part of the midwife's role, or is it for the GP/ clinic nurse to advise you on?

LittleBearPad Sun 23-Feb-14 09:55:32

Well it's probably important for women to understand that they can be fertile before their periods come back, that bf isn't a contraceptive etc. a passing comment might be useful but not too much time. The appointments are short enough as it is.

thatstoast Sun 23-Feb-14 10:01:10

It was discussed at my antenatal classes and by the community midwife and health visitor straight after the birth. I wouldn't object to it being raised during pregnancy but not sure what the benefit would be as you can't act on the advice.

Tbh, I took offence at it being brought up right after the kids were born while still in hospital and feeling like crap. I did not like getting a lecture on what is better and "long term contraception". I am an adult and perfectly capable of finding out which (if any) contraception I want to use, on my own.
And what if the plan was to have children close together? In my experience Doctora/Nurses do not like being told that you don't want to discuss this with them, and that's not fair.

Sorry, that was basically meant to say that discussions about contraception while still pregnant and have not yet had a safe birth are very OTT.

missismac Sun 23-Feb-14 10:32:54

Thanks Guys, I wondered the same about squeezing it in to the appointment littlebear, but some Midwives offer a 1 hour 'birth talk at 36 weeks so it might work better with that model of care? I know at our local clinic the appointments are still only 15 mins - it's very much get-em-in-get-em-out, I can't imagine how a contraceptive talk would fit in there?

thatstoast I suppose I thought the benefit might be, as littlebear said, understanding when you might be fertile again (3 weeks post birth) and to enable you to plan your family spacing rather than get a surprise pregnancy that you're not ready for. I appreciate what you say Schro, I remember feeling the same and looking at the Midwife not he postnatal ward in horror as she asked me about contraceptive - thinking 'you've got to be kidding right?'. And yes, there are families for whom it's right, and their choice to have a small gap, but for most women their bodies need a year to recover and gain strength between birth and subsequent conception. If a contraception chat at 36 would help women think about what they want with regard to family spacing and contraception over the coming year then might it be a useful addition to maternity care? I guess I was looking at the issue from this perspective rather than an intrusive lecture on what you 'should' do - which wouldn't be helpful to anyone!

CrispyFB Sun 23-Feb-14 12:02:43

My consultant asked me at my 34 week appointment but that is because I need c-sections and this will be my third, and she was basically telling me not to have any more babies which is fair enough (fine by me, four was always the plan!)

It felt odd talking about contraception when we'd TTC for 14 cycles to get this one, but the conversation has to come up at some point.

I actually think it is better before the birth because you're not as exhausted, you're probably in "planning" mode preparing for everything too. Getting people thinking about it and then the midwife or HV bringing it up maybe post birth to put those plans into action. Anyway, that's just my opinion!

I am sure a lot of people dont know that they could start back on hormonal contraceptives from 3 weeks after the birth as they think they have to wait until their 6 week check. A talk about contraception before birth could be useful.

SaucyJack Sun 23-Feb-14 12:30:39

I'm in my 30s, and quite capable of making my own contraceptive decisions thanks so I wouldn't appreciate anybody taking it upon themselves to "advise" me at any stage if I'm being perfectly honest.

pixiestix Sun 23-Feb-14 12:37:08

Maybe pre-birth would be better. I remember being fairly pissed off with midwives trying to talk to me about it 12 hours after the birth.

My MW discussed contraception with me postnatally. I think there might have been a checklist involved.

I'm not sure that talking about it antenatally would have been any more useful.

sallysparrow157 Sun 23-Feb-14 12:53:09

Those of you who feel capable of making their own contraceptive decisions, that's great but there are women who may not have thought about it or women who don't know all the options and age isn't an indicator, there are 16 yr olds who are more clued up than some 30 yr olds.
Contraceptive advice doesn't have to mean a 2 hour lecture, it could just be
'have you considered contraception options after the birth?'
'Yes, I'm going to do x/I'm hoping to have another child soon after this one so we won't be using any/not yet but I plan on looking into my options myself'
'Great, if you need any advice at a later date you know where I am'

Having this chat at 36 weeks probably makes more sense than having it 12 hours after birth when I'm sure the idea of doing anything needing contraception is enough to bring tears to your eyes!!

VivaLeBeaver Sun 23-Feb-14 12:57:46

As a midwife I have to talk to women about this before they leave the hospital postnatally. There's a little box in their notes to tick to say its been done.

Some women aren't capable of finding out the options. Some women believe they can't get pregnant before their first period and are amazed and shocked to find themselves pregnant a few weeks after giving birth.

If you don't feel the advice is of benefit just smile and nod. I'm sure some women don't find half the advice in pregnancy of benefit. After all they're capable of looking up advice about what foods to avoid, alcohol, ibuprofen, Vit a, exercise, smoking, etc themselves aren't they??? hmm

Women won't see the GP until six week postnatal checkup which could be too late for some.

Gobbolinothewitchscat Sun 23-Feb-14 12:59:04

Why does the midwife or the health visitor have to mention it confused

The GP mentions at the 6 week check and they tend to be a lot less judgey pants than either the HV or midwives in that in my experience they tend to have much better tone and are able to leave out the highly unprofessional value based judgements

Just hand over a leaflet, if you must at the appointments or stick something in the green notes

alwaysneedaholiday Sun 23-Feb-14 13:03:03

Yes, I would prefer this conversation before the birth. I'm not usually embarrassed easily, but for some reason I really did not appreciate talking about contraception immediately after birth, or even at the 6 week check.

I think just a leaflet about options and an offer to answer any questions is sufficient for most women.

Gobbolinothewitchscat Sun 23-Feb-14 13:04:08

I've got a 5 week old DD with only a 13 month gap between her and DS Thank God none of the midwives at the hospital brought up contraception or they would have got a very hard stare.

It's all so intrusive and big brother like. Most of us have managed not to get pregnant quite successfully for most of our adult lives before stsrting a family. Why would giving birth suddenly have robbed us of that skill?

As I've said, why not just have some leaflets available for the biologically challenged. The rest of us can google or rely on our previous skills which won't have deserted us just because we're "mummyz" now <boke>

purplemurple1 Sun 23-Feb-14 13:05:31

My midwife decided while I was birthing the placenta was the perfect time for the discussion. Before birth would have been beter than during.
It had taken 2 yrs and help to conceive, so not really relevant to us anyway.

Bubblegoose Sun 23-Feb-14 13:11:58

I'm with Schro and Saucy. Totally my decision as an adult.

When DC1 was a few days old a HV came to visit us at home. She asked about contraception and I looked at her like she was mad. She smiled wryly at me and said "I'll bet you any amount of money I'll be seeing you with a new baby in less a year's time."

I was 34 at the time and had been with my partner for 10 years and managed to avoid getting knocked up. Accidentally falling pregnant in the first few weeks after the birth of my first child with very little sleep and with lots of healing to do wasn't going to happen.

missismac Sun 23-Feb-14 13:14:30

Well Midwives don't HAVE to mention it antenatally, but they do postnatally - it's part of their job remit. As some of the other posters mentioned, if it's left to the 6 week check then for some women it will be too late and they'll have an unplanned pregnancy. One that possibly isn't welcome to them?

We all know that babies come, planned or unplanned and not everyone likes to live their life to a schedule, but I suppose I'm leaning toward favouring a mention by the Midwife in the antenatal period rather than no mention at all until, you've just pushed a melon out your vajayjay so as to give women a bit of time to mull it over. It doesn't have to be advice saucyjack, but would you have been offended if your Midwife had just asked you the question, as posed by sallysparrow upthread?

Gobbolino, I'm sensing Midwife antipathy? I'm sorry that you don't seem to have had good experience with your Midwives, I'm sure though that you're intelligent enough not to tar a whole profession with your experience with a few. Most of the Midwives I know are extremely hard working, caring and - mostly - intelligent women who come into the profession to do good in the world and help other women, not to make judgements. I hope you get to met some of this kind in the future.

SaucyJack Sun 23-Feb-14 13:16:51

SallySparrow

I do see what you're saying, but I still think HCPs should be offering women the chance to discuss contraception if they want to rather than straight out asking intrusive and patronizing questions at entirely inappropriate moments if they must "discuss" it at all. It might not seem like much of a difference to them, but it makes a Hell of a difference to those of us who don't appreciate being spoken to like naughty schoolgirls who've got knocked up behind the bike-shed.

I just object to my vagina being treated as public property, because I'm having a (much wanted btw!) baby.

SaucyJack Sun 23-Feb-14 13:17:51

Cross-post missimac smile

Gobbolinothewitchscat Sun 23-Feb-14 13:19:05

but for most women their bodies need a year to recover and gain strength between birth and subsequent conception. that's nonsense for a kick off. Unless - in some instances - the woman has had a c section, or a bad tear or some other medical issue. Please don't be spouting this bollocks to people. Who told you that?

If a contraception chat at 36 weeks would help women think about what they want with regard to family spacing and contraception over the coming year then might it be a useful addition to maternity care? Is it not the case that more women than not will already have been thinking about this without any tip offs from the midwife?

Honestly, it makes me really sad that midwives work on the basis that the women that they see are of such low basic intellect that they need the midwife prodding them to see this. As I've said above, do you not think that most people have been able to successfully family plan before they ever set a toe in a midwive's office?

Yes - there will be the chaotic few who have got pregnant accidentally 5 times or who can't cope with the children they have. However, they are the general exception in most cases and are easily identified for a more thorough and tactful discussion, if they seem receptive.

It's this one size fits all, failure to properly read situations etc that make most of the people I know disengage with midwives/health visitors. Doctors seen much better at quickly sizing up situations and tailoring their advice accordingly

Genuinely, why is that? Better training? Better emotional intelligence?

Gobbolinothewitchscat Sun 23-Feb-14 13:25:00

No - just antipathy with some midwives and with you. Rather than putting the onus on me. Maybe it would be a good idea to try and have some insight into your thoughts//behaviour? I don't seem to be the only person on the thread who finds your proposals rather, er.......patronising?

Being "hard working" and "caring" is not to the exclusion of being patronising and misguided.

MinesAPintOfTea Sun 23-Feb-14 13:27:47

Who is this project for? How are you making sure you have representative views of the whole population on this?

Most parents will have an idea of what family spacing they want already, they don't need midwives to suggest they think about it. Maybe a prompt to get back on the contraception post-birth (as used to not using it) but not to plan their lives!

As for me, I nodded and smiled at the midwife when she gave me "the talk" in hospital post-birth. Then again when the GP did at my 6 week check. It was only when DS was always sleeping through the night and I had recovered physically from the birth months later that I took myself to the GP as I had done for a decade prior to getting pregnant.

OrangeFizz99 Sun 23-Feb-14 13:29:57

They need to filter. I can't take hormonal contraception and their little speech makes me bored each time.

mrsbug Sun 23-Feb-14 13:31:07

I have no recollection at all of the midwife asking me about contraception before I left hospital. That's not to say they didn't; it's more likely that I was preoccupied by other things (like not having slept for a week, or establishing bfing) to have paid the question any attention.

So for me, having it mentioned at an antenatal appointment would have been better. My antenatal midwife was great and none of the potentially offensive questions she had to ask were a big deal (smoking, drinking, domestic violence etc).

However, bear in mind that a significant minority of babies are born before 36 weeks so these mums could get missed out.

Did nobody else get MW visits at home post-birth? I think my MW raised the subject at about 8-10 days, just before he signed me over to the HVs.

BoffinMum Sun 23-Feb-14 13:34:59

I think they should speak about the effect pg and birth has on contraceptive choices, eg diaphragm needs refitting, hormones may be unpredictable, impact of bf on mini pill, that kind of thing. Mirena coil advice might be useful as well. but basic contraceptive advice would just come across as patronising and as though we shouldn't have bred in the first place, as though we have somehow fallen by the wayside. Practical post birth scientific information immediately relevant to the postnatal state is probably what most people want and expect.

expatinscotland Sun 23-Feb-14 13:36:14

In my case the only 'conversation' was angled towards trying to get me to let them shove a Mirena up me. If you are in your 30s, they treat this like the only option there is.

BoffinMum Sun 23-Feb-14 13:36:29

BTW if I had that kind of information aimed at me at 36 weeks I would point out that there was a reason I hadn't been pg every year of my adult life, and that would be USING CONTRACEPTION. <duh>

BoffinMum Sun 23-Feb-14 13:38:28

I think efforts would be better spent checking pelvic floors more thoroughly and referring more women on for specialist gynae services so we all have better sex, like in France. Many women are repaired very badly and it makes them miserable, and a few clenches at a bus stop once a day sure ain't going to make any inroads there.

BEEwitched Sun 23-Feb-14 13:39:52

The issue was raised with me at my booking appointment at 8 weeks - I thought it was ridiculous; I had heard from others that contraception was going to be discussed with me, and I didn't welcome it but was prepared to nod and smile.

But at 8 weeks pregnant, when I'd already been to EPU for bleeding and was having complications? It felt totally inappropriate and, to be honest, absolutely fucking stupid.

sallysparrow157 Sun 23-Feb-14 13:40:05

This stuff is basic health surveillance. Of course many many women know enough about contraception (or have the sense and ability to look up what they don't know) that for them this conversation isn't necessary. But there are plenty of women who don't know or have been misinformed (being unable to get pregnant whilst breast feeding or before first period is a very very common misconception), there are plenty of women who don't know what contraception they can use when breast feeding, there are plenty of women in abusive situations where a partner may refuse to use contraception or let them access contraception.

The midwife doesn't know just by looking at you which group you fit into. So she has to ask everyone these questions so as not to miss the one vulnerable woman in her caseload. Just think how discriminatory it would be if she only asked the women she thought were a bit clueless and how shit you would feel to be asked if you knew this was the case!

In paeds we have to ask every single family seen in hospital if they are receiving any support from social services. If I made a judgement based on appearances and apparent intellect and only asked the families who looked 'that type of family' I would be being pig ignorant and discriminatory.

If we only did smear tests on people who'd had multiple partners we would miss cases of cervical cancer and being chosen for a smear test would have certain implications!
And so on and so on!

The whole point of this type of health surveillance is that everyone is asked so nobody is missed because they don't fit into a stereotype and nobody feels discriminated against by being selected out to be asked.

BEEwitched Sun 23-Feb-14 13:41:46

Oh yes, and as someone who's been on Cerazette for ages and gets a leaflet about the mirena every few months I'm fed up with the whole thing anyway. I'm aware that when I'm at the GP, a little box pops up on their screen that tells them to steer me towards longterm contraception. I've seen this at midwife appointments, as well.

I don't appreciate being constantly hassled about that.

higgle Sun 23-Feb-14 13:47:09

My response would be " fuck off and mind your own business". I hate being patronised by health care professionals who have boxes to tick.
I wasn't asked with either of mine, but as I was paying a substantial bill first time round I would have thought it even more rude than in the quota filling one size fits all NHS. I do remember the second time around the community midwife asking if I was planning any more but fortunately she did not continue the conversation when I said I thought 40 was too old for me to contemplate a third.

So if a MW that you've been chatting to for nearly 9 months about your various bodily functions politely asks "Have you thought about what contraception you will be using", your response is "Fuck off" rather than "Yes I have, thank you for asking".

higgle Sun 23-Feb-14 13:51:55

Yes, Gobbolino - I managed for twenty years of very active sex life without some womand less educated than me having to explain how babies came about, your "hard stare" is a pretty low level response to such nosey rudeness.

VivaLeBeaver Sun 23-Feb-14 13:52:48

I'd like to think that my contraception talk is brief and inoffensive.

Goes something like "here's a leaflet on contraception, have you any questions on specific contraception, just be aware that you can get pg before your first period so be careful".

I'm supposed to ask them specifically what method of contraception they're planning to use and enter that on the computer system. Why I have no idea. I must admit I don't tend to ask and just put "undecided" on the computer.

VivaLeBeaver Sun 23-Feb-14 13:53:55

Higgle, how do you know a midwife is less qualified than you?

higgle Sun 23-Feb-14 13:54:44

Chatting to for 9 months? I hadn't met the two who did my home birth until the day, and then I saw 3 different community midwives over the following 28 days. They were all very nice, but I'd no more expect them to discuss my private arrangements for my body than ask me how much my mortgage was.

expatinscotland Sun 23-Feb-14 13:54:47

'thanks, but I don't want a coil.' 'But it will stop your periods.' 'I had a coil I bled for 10 months straight.' 'It might be different this time.' 'I DON'T WANT A COIL!'

I get really sick of this.

WinterDrawsOff Sun 23-Feb-14 13:55:24

To answer the question - I wouldn't appreciate a MW offering contraception advice at any stage in my pregnancy or post birth. I do not think it should be within their remit. I do not appreciate the "tick in the box" attitude which smacks of doing something for their records, targets or service level agreements and not for my benefit. Unless the MW can provide contraception there and then, what is the point of the question?

I think if midwives were able to initiate a sensitive, open-ended conversation on family planning then that would be fair enough to include during conversations. Personally I'd prefer that during a routine and quiet ante-natal appointment than after things may feel much busier when the baby has arrived and you may have so many other questions.

Can they not just ask whether you are planning any more and perhaps ask of your experiences of ttc this one and what contraception you were using before that, and whether you are still happy with that choice.

Having a baby after a 9 mth pregnancy and perhaps on average a similar amount of time before that of ttc does herald a change in the situation which it might be helpful for at least a significant minority to have the opportunity to discuss.

Also thinking as long as it's not a one size fits all approach eg not everyone will want or need to go on the pill at 3 weeks pp.

VivaLeBeaver Sun 23-Feb-14 13:57:24

Oh and research has shown that nearly 40% of pregnancies are unplanned so those who have managed 20 years of successful contraception carry on feeling smug with yourselves but please realise that you are not everyone.

higgle Sun 23-Feb-14 13:57:55

Viva, at the time I had my babies i had postgraduate qualifications and was partner in a very large law firm. I concede there may be the outside possibility of a few having better academic qualifications but as i generally research anything concerning my health in detail I have tended to be quite shocked that the NHS often expects you to follow advice that is not up to date.

VivaLeBeaver Sun 23-Feb-14 14:00:01

Wintersrawsoff, because if a woman says she wants to go on the pill or whatever then the midwife can make sure she knows that until she gets it prescribed she needs to use an alternative method. Believe me there are a lot of women who don't realise they could get pregnant pretty much straight away.

Some women may also want to discuss breastfeeding as a method of contraception so I can discuss points about that which they'd need to know.

VivaLeBeaver Sun 23-Feb-14 14:01:22

Well higgle I have two degrees and a masters as well as plenty of post grad level professional qualifications and am looking to start a phd. So please don't assume that a midwife isn't very well qualified.

SaucyJack Sun 23-Feb-14 14:03:15

Viva

I have to say, I would be incredibly monumentally offended for you to enter "undecided" on my permanent medical records, when the truth is I'm perfectly happy with my contraception decision but I simply don't wish to discuss it with someone I don't know from next door's dog.

WinterDrawsOff Sun 23-Feb-14 14:03:50

Viva - that makes sense. Do you offer contraception?

VivaLeBeaver Sun 23-Feb-14 14:08:16

Nope, sadly we can't prescribe contraception. To be honest I've never known anyone ask for contraceptive pills. I suppose if someone really wanted them before they left I could get an sho to prescribe them.

SaucyJack, mmm good point. Although the bit of the system it goes on doesn't get printed out on your take home post natal notes or go to the GP so I doubt anyone ever sees it again. And I have to put something in that box or the computer won't let me discharge the woman.! grin. So I either try to be sensitive and realise women don't want to be asked the specific question.....as well as thinking its not really my business as long as I give them enough basic info so they're not back in nine months (unless the want to be), or I ask them and risk offending the woman and been told to fuck off. What do you think would be better?

higgle Sun 23-Feb-14 14:09:22

It is the lack of person centred approach in the NHS that really annoys me. One size fits all, lowest common denominator. GPs are usually quite good, they tend to know about most recent research and if I want to discuss the merits of breaset screening with mine whe will usually know about the recent research and findings. The practice nurse always has this "because I says so, because its good for you" approach that means I simply don't see her any more. Yes, advice should be tailored to peoples general degree of knowledge and perhaps even their means if it is clear they might want to pay for something non NHS . I'm afraid the final straw for me recently was an entry level type large print communication about health checks that the average 5 year old could have written. It was not difficult to analyse the risks pertaining to the main conditions mentioned and check out if it was worth having the tests.

I'd take issue with the comments about pregnancies that are described as accidents and unplanned, andy unpreotected sex can result in pregnancy and the morining after pill is widely available.

VivaLeBeaver Sun 23-Feb-14 14:15:04

Higgle, I suspect it comes down to funding and staffing a lot of the time.

On a postnatal ward a midwife can be looking after 13 women and babies. Half of whom will want discharging and discharging ASAP, the others might be poorly, have a baby on IV antibiotics, etc, loads of stuff keeping them busy.

I don't have time to go through people's a/n notes and see what their education level is. Anyway some people with degrees are still quite dim, some people with no qualifications are very switched on. And like I said earlier the computer insists on an answer in the contraception section or the discharge can't be done! Plus if the notes were audited and I hadn't filled that section in I'd get a bollocking. I'm quite happy if someone doesn't want to discuss it if they politely say so. I'd object to being told to fuck off. Sadly the computer doesn't have "doesn't want to discuss" as an option in the drop down list.

higgle Sun 23-Feb-14 14:21:06

Maybe in real life I might not be impolite back, Viva, I'd prbably give a nonsense response to mess up the statistics ( in the hope that NHS would stop spying on us) such as "I'll make sure only to do it standing up". Or if I remembered I was on MN I'd say "Did you mean to be so rude?". smile

BoffinMum Sun 23-Feb-14 14:26:11

A lot of people barely see the same mw twice, so the 'chatting for nine months about various bodily functions' thing is a bit of a joke.

satintaupe Sun 23-Feb-14 14:26:17

I wouldn't appreciate it. It was mentioned by the hospital before I was discharged as it was on a checklist of things they have to tick; they advised waiting a year before getting pregnant again as I'd had a c-section. That was enough in my opinion. A friend told me that they had a lecture from their midwife on contraception after giving birth, so I was dreading this, but I didn't get one. I informed them that my pregnancy was planned in my booking in book (it's a question on there), so although I understand why they do inform people, after being with my husband for 15 years before having a child I would have been annoyed if I'd received a lecture.

sleeplessbunny Sun 23-Feb-14 14:29:48

I think before the birth is better than after, but there is no right time really, it will always be an awkward conversation IMO. I remember being asked by the MW (or HV?) a few weeks after DD's birth "so what are you doing about contraception now, then?" I just looked at her like she had two heads and said "never having sex ever again, obviously" (it wasn't a great birth and I was still in a lot of pain). I would have been much less arsey about it before the birth.

HolidayArmadillo Sun 23-Feb-14 14:37:28

Is it really that big a deal? I like Viva have to bring it up on the postnatal ward, usually in the form of 'just so you know you can get pregnant just 3 weeks after giving birth and before your periods return, it's not unheard of to attend your 6 week check and already be pregnant again, so unless that would be welcome surprise or indeed a planned pregnancy just bear the above info in mind, here's a leaflet that covers the types of contraceptives compatible with breastfeeding and when they can be started' I've never had anyone object, tell me to fuck off or mind my own business. A lot of people express surprise that pregnancy can occur again so quickly and before their periods return. I don't think mumsnet is representative of the general population. Certainly not in the area in which I work.

Imonlydreaming Sun 23-Feb-14 14:38:07

What I objected to in this instance was having to explain male factor infertility to the midwife and how it was EXTREMELY unlikely to happen naturally and IF it did thrilled would not even cover it!

weebairn Sun 23-Feb-14 14:40:49

I have no idea why people are offended by this. If it's not relevant to you because you already know what you'll be doing (or not doing) - just say so? I'm baffled by people who think it's too personal when someone's just watched a baby come out of you.

It's not uncommon for women to have accidental pregnancies shortly after birth so if a little reminder helps some women, why the hostility?

My midwife asked me at some point postnatally, I can't remember when, and my GP asked at my 6 week check. I did have unprotected sex at around 3 weeks, which was silly and not like me, I blame birth and hormones and sleep deprivation. I was EBF and it's a common myth that you can't conceive. I did a pregnancy test, breathed a sigh of relief, used condoms and got a coil a bit later.

I think before birth is more sensible than immediately after, your head can be spinning a bit immediately after!

HolidayArmadillo Sun 23-Feb-14 14:46:38

Thing is if you've had IVF or whatever then I don't know why you have had IVF, for all I know it could be 'unexplained infertility' and the amount of surprise second pregnancies that come through the doors following IVF first time round indicates that contraceptive advice may be useful. I don't get the taking offence, if it doesn't apply to you then ignore it, move on and accept that actually for a large amount of the population the advice is if not welcomed but certainly not seen as a personal attack on your lifestyle or choices.

Gobbolinothewitchscat Sun 23-Feb-14 14:49:16

The analogy with SS in paeds is totally wrong. That is different as you are dealing with children. Most people givi g birth are sentient adults!!!

If you must - Just give everyone the leaflet sparrow but make sure you offer to read it to them. They might be dyslexic

I'd do a lie detector test too. What if all these adult women aren't telling the truth and the leaflet goes in the bin.

In fact, why not just give us all a contraceptive injection. Just to be on the safe side hmm

Nocomet Sun 23-Feb-14 14:52:57

DF, who's DDs are IVF after many many years of TTC said she nearly had a fit of the giggles at the postpartum contraception talk.

She had to admit the MW might have had a point when they gained a most unexpected baby brother.

colleysmill Sun 23-Feb-14 14:56:40

I remember last time the mw talking to me about contraception and we laughed together tbh as I was post csection and just about walking with an infected wound let alone planning bedroom gymnastics!

I have to agree with expat in that when I did go and get it sorted last time round they were very keen to promote the coil rather than any other options as if the coil is the answer to every womans needs.

I think an open ended asking the woman if she needs information on contraception would be the best policy.
I wouldn't personally be offended but it sounds like some would, and I agree it makes the assumption that women wouldn't want to have two close together when some do.

blueshoes Sun 23-Feb-14 15:04:17

I am with higgle.

In RL, I just smiled and said to the midwife that I managed to get to 35 years without falling pregnant accidentally so I do know something about contraception and I am sorted. End of Conversation.

I did feel patronised and thought it was none of their business, particularly after I had a traumatic emcs with dd. The NHS seem to have bizarre agenda to push long term contraception onto women who have given just birth (coil, implant??). My brother who is a GP raised the very same issue with me (wtf!) and I told him to fuck off basically. But with the midwife, I was matter-of-fact because I know she is just doing her assembly-line box-ticking exercise to the contraceptive-free blethering idiots she no doubt encounters.

missismac Sun 23-Feb-14 15:57:32

Oh dear, I'm sorry that you've taken offence gobbolino - it wasn't my intention to offend or be patronising. I apologise if it seemed that way to you - and I don't mean that apology in a patronising way at all.

The ideal of one year between pregnancies for a woman's body to recover is well documented in various obstetric literature, government sexual health guidelines and policy frameworks. I haven't read anywhere that it's bollocks, but am happy to be shown the light.

Mine'sapintoftea of course, this isn't proper research. I am writing an essay on the role of the midwife in promoting sexual health & I'll be using proper, ethically approved research in that, but like most of the posters on Mumsnet I posted here because I just wondered what people thought about the subject of antenatal vs postnatal contraceptive information offering. It interests me, and as I said, personally I lean toward an antenatal conversation rather than a postnatal, but it's interesting to hear other people's views to get a bigger picture.

It seems from the Midwives who have posted here (thank you viva and Armadillo) that they have to do a very careful juggling act. A lot of people seem to be saying that it's easy to feel offended or patronised by Midwives asking these questions, but under EU regulations the Midwives are obliged to ask. Contrary to some of the views expressed here not everyone has the education or capacity to access contraceptive advice and there will be those women for whom the question may be an opening into a conversation that is helpful to their future family planning - is it worth risking offending a few to ensure those that DO need it get the right support? From my perspective I think it is but accept that there wil be those who feel differently.

The NHS is often a one-size-fits-all-service, it is one of the limitations of a large institution dealing with hundreds of thousands of women a year, and I think it's important to acknowledge that. The service providers do their best, but it's by no means a perfect service - show me one that is! However some women are served by caseload midwives and they do see the same midwife and build a relationship with them over the course of the 9 or 10 months they see them. For them perhaps the question might feel less embarrassing/intrusive/patronising?

blueshoes Sun 23-Feb-14 16:15:48

missi, if it was the same midwife with whom I built up a relationship over a pregnancy, it would feel a lot less intrusive whether ante- or post-natal.

I am interested you say that EU regulations require midwives to ask. What are these "EU regulations" and do they have the force of law or are they just a recommendation? <finds it staggering that the EU is such a nanny state>

LittleBearPad Sun 23-Feb-14 16:28:18

Why on earth is it intrusive? If you don't want to have a long conversation say that you've decided to use x, y or z and will discuss it with your GP.

There's a lot of unnecessary grumpiness on this thread.

MinesAPintOfTea Sun 23-Feb-14 16:40:02

Little its intrusive because the discussion is often taking place with a HCP you might not have spoken to before, with your DP present and in a bay with other women in. Plus its usually a laughable concept.

VivaLeBeaver Sun 23-Feb-14 16:49:07

There's loads of questions in pregnancy which are intrusive.

My GP asked if it was planned and whether I was happy or not. I'm sure many would take that as intrusive.

Some women feel that been asked if they're being subjected to domestic abuse is intrusive.

LittleBearPad Sun 23-Feb-14 16:50:23

Compared to the internal exams, stitches and then god knows what of labour a midwife asking about contraception doesn't seem overly intrusive to me.

LittleBearPad Sun 23-Feb-14 16:52:01

And I didn't see a single midwife more than once. So it's hardly like the ones checking how dilated I was and I had established a deep and meaningful relationship.

VivaLeBeaver Sun 23-Feb-14 16:53:01

Big buzz phrase in midwifery now is "shop window", that maternity services are the shop window for the nhs. That many people can go years without accessing the nhs but maternity is the one service that the majority of people will come into contact with. That includes men as partners as well as the pregnant women.

The gov are pushing maternity to take on more of a role for public health. So to be very involved in areas such as obesity, smoking cessation, mental health and family planning/contraception.

SaucyJack Sun 23-Feb-14 16:56:47

Why on earth is it intrusive?

Because it's my sex life and my vagina, and I reserve the right to be as grumpy as I like when complete strangers start asking me uninvited personal questions.

It wouldn't be a welcome or appropriate question if I was seeing a HCP for an ear-syringing appt, so I don't see why all tact or dignity should go out of the window just because I've had a baby. I've been sexually active for 17 years. I do not have 17 children. Do the maths.

If one really must raise the subject because the EU says so, then asking me if I would like to talk about it- with no comment if I decline- would be the least worst option as opposed to just launching straight in.

missismac Sun 23-Feb-14 17:05:09

blueshoes It's here: http://www.euro.who.int/__data/assets/pdf_file/0005/102200/E92852.pdf. Article 42: 2 (a)

missimac - you do know that you've just linked to the WHO website, which has nothing to so with EU regulations, don't you. And your link doesn't work.

higgle Sun 23-Feb-14 17:19:22

I feel this whole approach is very patronising to women. If I hire or engage someone to do a job for me I expect them to do the job and not to ask me questions about things I haven't asked for advice about.
I'd be just as put out if the eprson I'd engaged to service my car tried to flog me a new one.

VivaLeBeaver Sun 23-Feb-14 17:20:32

Mmmm, but you haven't hired or engaged a midwife to do a job for you. Not unless you've employed an independent one.

What about if the person who serviced your car pointed out that your tires, although OK for now, were getting close to being illegal and that they advise you to plan to replace them in the next 6 months? Would that be overstepping the mark, or giving you useful information which enabled you to make an informed choice in a timely fashion?

Mignonette Sun 23-Feb-14 17:24:50

The last person I'd ask about contraception would be a MW. They are hardly experts on it and I wouldn't engage in a discussion with her about it. If I wanted contraceptive advice I'd have gone to either a specialist clinic or my GP - the one in my practice with a special interest in this. MW's really aren't in possession of what I would deem expert knowledge.

To be honest I fear I am fairly untypical of a lot of women in that i wasn't at all invested in developing a relationship with my or any midwives- I wanted to be seen quickly, in and out and have my baby delivered efficiently by somebody working from a non judgemental evidence base.

I do think that a lot of what you hear being said by MW's about how fulfilling it is to develop close relationships with their clients comes from the perspective of having their needs met as opposed to those of their clients. The women in their care are not there to meet their psychological needs.

VivaLeBeaver Sun 23-Feb-14 17:24:54

It depends on what's wrong with the car at the service. If its a year old car then I'd be hmm

If its a ten year old car with a crack in the cylinder head gasket and a dodgy water pump I'd think fair enough.

Contraceptive advice is linked to midwifery. Its not like you've gone to the dentist and they start advising you about the coil.

Mignonette Sun 23-Feb-14 17:33:13

Miss

to be honest a fellow professional isn't always the best and most impartial judge of her own colleagues except from their own perspective.

Have heard some pretty poor HCP behaviours and practices defended by the colleagues of those responsible for them.

It has to be said that when some OBGYNs are now having a dialogue about choosing words carefully when discussing birth and conditions such as 'imcompetent cervix' whilst many MW's and especially some MW tutors continue to use the terms 'normal' and 'natural' birth when so many women are telling you they object to them.... Well you wonder about humility.

As was said to my stepdaughters MW tutor 'normal birth/natural birth as opposed to what? If you have any MW care during PG and birth your birth is no longer 'natural'. Why not 'Minimal Intervention Birth'.

BTW my MW told me that if I was fully BFing my son, I would be protected from PG. Yeah right.

LittleBearPad Sun 23-Feb-14 17:37:41

What an odd viewpoint Higgle.

VivaLeBeaver Sun 23-Feb-14 17:44:22

Mignonette, that midwife is pretty much right. If you fully follow the guidance for using breastfeeding as contraception then only 1 in 200 women will become pregnant. Which makes it as good as the pill. But its not as simple as saying breastfeeding will stop you getting pregnant, there's various "rules" that need to be followed.

From nhs website

Lactational amenorrhoea method (LAM)

Women don't have periods while they're breastfeeding (this is known as lactational amenorrhoea), so breastfeeding can be used as a form of contraception. This is known as the lactational amenorrhoea method (LAM).
The fertility signals used in natural family planning methods are not reliable in women who are breastfeeding.
Women who are fully (or nearly fully) breastfeeding can use the lactational amenorrhoea method for the first six months after their baby is born, as long as:
the woman has complete amenorrhoea (no periods at all)
she's fully or very nearly fully breastfeeding (this means that the baby is having breastmilk only, and very little or no formula)
the baby is less than six months old
When used correctly and consistently, one in 200 women who use LAM will get pregnant in the first six months. However, take care to use the method correctly. Don't feed your baby other foods because this may reduce your lactation.
LAM becomes unreliable when:
other foods or liquids are substituted for breastmilk
your baby reaches six months old
After having a baby, it is possible to get pregnant before your periods start again. This is because you ovulate around two weeks before your period. For more information on breastfeeding, LAM and other reliable methods of contraception, talk to your health visitor, midwife or doctor. You can also read about breastfeeding in the pregnancy and baby guide.

expatinscotland Sun 23-Feb-14 17:46:48

I just wish they'd stop hard-selling that fecking Mirena without a thorough discussion of everything else that might be an option.

Mignonette Sun 23-Feb-14 17:50:46

Viva it isn't something you should reply upon because the variables...Well they vary too much. The MW provided no education about what total BFing meant w/ regards to amneorrhoea (I am a HCP fortunately in this case and realised she wasn't offering the best advice because it came w/ no education whatsoever). This was the same MW who advised me to give my hungry baby a top up bottle (sorry for dripfeeding) so obviously I realised that her advice was nonsensical in context.

Mignonette Sun 23-Feb-14 17:52:04

Viva

I appreciate you posting that info though - you never know who might be reading and find it useful smile

VivaLeBeaver Sun 23-Feb-14 17:53:19

It can be relyed upon if you stick to the rules. I wouldn't be so judgemental to assume that someone isn't capable of following them. Make sure the baby is under six months and don't give them anything else to eat/drink apart from breast milk. Its not rocket science.

WhoWasThatMaskedWoman Sun 23-Feb-14 17:54:31

There are a huge number of unwanted pgs in the UK every year. If being asked a brief question which isn't relevant to me is the price of some women being spared an abortion or a child they can't really cope with then feel free, and I tend to agree that 36 weeks might be a better time than 12 hours after birth. Likewise, pushing a contraceptive option that's 99.8% effective rather than one that's 98% effective might reduce the number of women needing abortions by a factor of ten, and that's worth the odd spammy text to my mind.

But it does need to be handled sensitively, and midwives are obviously pissing a lot of people off by their approach.

VivaLeBeaver Sun 23-Feb-14 17:54:49

Thanks. I don't think it would be on the nhs website if it couldn't be relyed upon. One of my old tutors had done the research/studies into this so was a big advocate.

missismac Sun 23-Feb-14 17:56:57

Oh my goodness mignionette I hope you're not thinking that I am setting myself up as any kind of judge of anyone? No, no, no. I'm just saying what I see each day.

Language and its use has always been, and possibly will always be, a contentious issue. You only have to read Orwells 1984 to see that it's unlikely we'll ever get away from that. 10 years ago I trained to teach adult education classes. we we're told never to refer to a group of women as 'girls' or 'ladies', and never to refer to a group of men as 'boys'. however sometimes these terms feel appropriate in close knit and informal situations and 'women' and 'men' feels stilted and unnatural. My point is, with language, no-one can get it right all the time - what works for you may be offensive to someone else.

And no, I didn't know that the link didn't work - Thankyou for alerting me. I wouldn't had posted it if I'd known that. I'll go back to the page and try to get the right one.

Mignonette Sun 23-Feb-14 18:00:25

What is the research about introducing top up feeds before BFing is established though? And especially when the advice was that top up feeds could be continued? Full BFing needs to be established first especially prior to milk coming in.

Thankfully I knew that she was offering poor advice because it was tick box advice without any attempt to establish that i fitted into the box.

This MW (from a London hospital that parades its MW training as some kind of 'gold standard BTW) simply didn't educate properly because she failed to establish the 'rules' and it wasn't an isolated example either.

The issue I have with this kind of health education is that MWs simply don't explain the full facts, mostly due to lack of time but often because they don't know and some of them appear to be a muddle of old wives tales, colloquial knowledge and evidence base. It is quite perplexing.

Mignonette Sun 23-Feb-14 18:03:03

No I don't think that Miss but I do think that it is possible to choose words and to not dismiss women when they say 'we don't like it' - not that I am saying you are doing that smile.

The term normal birth is offensive- I'm not the only one to say that and when leading OBGYNs are starting to question these terms you have to say 'well maybe we are being not as progressive as we think we are'.

missismac Sun 23-Feb-14 18:06:30

I've just copied and pasted the link from here to check it & it works for me. It takes me to a pdf of the European Union Standards for Nursing and Midwifery. I'm not techno-savvy enough to know how to fix it otherwise - maybe there's a link to it from the WHO website? Sorry I can't be more precise Mignionette .

VivaLeBeaver Sun 23-Feb-14 18:10:33

No, I'd never recommend it if top ups were happening. That's poor advice.

I really do try and make sure that everything I talk about is up to date and evidence based. If someone asked me something and I wasn't sure I'd be honest and go and find out. I'm passionate about excellent care for women and read journals and subscribe to nice updates, rcog updates, do a lot of reading, etc.

Sadly there are midwives who apart from their mandatory annual training don't seem to do anything after qualifying. They need a kick up the arse. We're supposed to be accountable professionals and I don't see how you can be if you don't take responsibility to make sure your practice is of the highest standard.

Mignonette Sun 23-Feb-14 18:13:30

The fact that you have engaged in so much PG training clearly sets you apart Viva from some of the MWs I saw.

The same issue is in MH - some staff get away with resus, MHA training and think that suffices.

VivaLeBeaver Sun 23-Feb-14 18:14:01

I haven't used the term normal birth for years and years, well over five years, probably nearer ten. Vaginal birth, section or instrumental.

Likewise failure to progress I'd never use, but I hear Drs saying that all the time. I don't hear midwives saying it. Possibly to each other but not to the women. Sadly its still on the drop down computer option list as a reason for a section or for augmentation.

readysteady Sun 23-Feb-14 18:17:24

When I had my first child I was asked 8 times about my contraceptive choice for the future. I politely said I was fine thank you. They hated that I didn't name my method and so the box wasn't ticked so each midwife asked. I was extremely emotional and was soon to go from baby blues to PND. I really thought they were telling me off for getting pregnant (very much planned) and were wanting me to prove that I wouldn't do it again as I was such a bad mother. I sound irrational I know but it actually contributed to my PND and caused me huge anxiety. Though I am sure you will think this is crazy I was exhausted and had AND so not thinking straight.

WinterDrawsOff Sun 23-Feb-14 18:18:25

Failure to progress = failure to wait!

Mignonette Sun 23-Feb-14 18:21:36

Glad to hear that Viva. My stepD is being trained to use normal/natural and I hate it. She is in her 2nd term and still revers her tutors as Gods who speak the Absolute Truth.

BoffinMum Sun 23-Feb-14 18:24:13

A normal birth is one that has a baby involved as opposed to a Sigourney Weaver special.

BoffinMum Sun 23-Feb-14 18:24:41

Or I would also add Rosemary's Baby to the list. grin

MrsM2013 Sun 23-Feb-14 18:27:37

I'm a doctor with 18months of O&G experience and a postgraduate diploma to boot. I managed not to get pregnant until I planned to and think of myself as fairly well educated.

I'm more than happy for a midwife to ask me about my contraceptive plans, despite being pretty clued up about every method under the sun. It's not rude or nosey- and they have plenty of other things they could be doing believe me. It is however part of a duty of care to make sure women are informed that pregnancy can happen quicker than many realise- certainty post natal fertility didn't feature in my GCSE biology class so you cannot expect everyone to be aware.

I personally feel that antenatal discussions would be better placed and better received as women are generally not at their most receptive immediately post delivery. I do agree that how the question is phrased makes a difference. I would however object to myself or one of my colleagues being sworn at on the basis of asking if contraception had been considered.

jellyandcake Sun 23-Feb-14 18:29:22

I don't see why this question would be offensive. A proportion of women being asked it will have had an unplanned pregnancy or contraceptive failure which has led them to the 36wk appt/postnatal ward anyway so may well find advice on this helpful. Those who are fully on top of it can just say they are happy with their previous method or that they don't require advice. I've had a difficult pregnancy and don't plan to have any more children after this one so I wouldn't object to being warned about how easy it might be to become pregnant again quickly - yes, I know this but if I didn't know and fell pregnant again it would be devastating. A quick chat either at 36 weeks or after the birth may save someone from that and hardly inconveniences anyone who doesn't need the advice.

After my first pregnancy, I definitely needed the time to recover physically, emotionally etc before planning another pregnancy - I thought the advice about leaving it at least a year before ttc was very sound and personally I wouldn't have coped with a subsequent pregnancy any earlier than that. Again, some women can cope and they are free to make an informed choice to disregard that advice - I don't see why you would want it denied to anyone else though.

Mignonette Sun 23-Feb-14 18:38:54

I might sound pissy on here but I have never sworn at a HCP - even in Labour. I couldn't do that only at NPower and AOL

Gobbolinothewitchscat Sun 23-Feb-14 18:45:10

EU regulations require you to ask the question about contraception? EU regulations have direct effect in terms of UK (and other member states legal systems) which means essentially they are law which must be complied with.

So it's the law that you do this? Sorry, I'm a lawyer too and I don't believe this. I think you must be mistaken. I really do not want to be rude and I swithered about whether to post - but your post reads as I've set out which just can't be right.

Separately, regarding the one year waiting period, I've discussed this with my GP and a consultant - as I have 13 months between my DCs. They both told me that the current advice which should be given is to look at a woman's previous obstetric history. There is no one size fits all - you must wait a year mantra.

missismac Sun 23-Feb-14 19:26:41

I did post a link to the EU standard gobbolino so you can check it out for yourself. mignionette said that it took her to the WHO page, and I can only think that it must link from there as when I paste it it takes me straight to the EU standard PDF.

It's Article 42. Pursuit of the professional activities of a midwife
1. The provisions of this section shall apply to the activities of midwives as defined by
each Member State, without prejudice to paragraph 2, and pursued under the
professional titles set out in Annex V, point 5.5.2.
2. The Member States shall ensure that midwives are able to gain access to and
pursue at least the following activities:
(a) provision of sound family planning information and advice;

etc.etc. Clearly I'm not a lawyer so I don't know the legal in's & out's of this, but my understanding is that it's what the postnatal contraceptive question is based on.

If you can remember and are willing to post it I'd be interested to know the evidence base for the current advice given by your GP & Consultant? All I've been able to find from the WHO, DofH & various research databases is the one year thing, but I'm no expert - just a student so if advice is changing then it would be good to know about it and to know what the new advice is based on.

That is advice from WHO to EU states, saying that MWs should be able to provide family planning advice - not that they should be compelled by law to force women to accept family planning advice.

I read is as meaning that MWs must be professionally competent to give the advice. The WHO is providing a framework for the basic standards of MW training across all EU countries.

Gobbolinothewitchscat Sun 23-Feb-14 19:57:41

That doesn't say you're legally required to ask women about their contraceptive choices. I'm really glad you posted here because it would have been totally professionally embarrassing for you to have told a patient that. Not to mention misleading.

Re the advice I got from the GP and the consultant, I took it at face value and didn't ask them to provide me with the research they relied upon. However, one of my friends tragically suffered a full term still birth 6 weeks ago and has been told that there is nothing stopping her trying for another baby as soon as she mentally feels fit to. This was by another consultant at the same hospital. So that's either two misguided consultants.....or.....?

missismac Sun 23-Feb-14 21:37:57

Ahh OK so that document is the WHO advising the EU that Midwives should provide family planning advice? So the contraception question Midwives have to ask at postnatal discharge is probably UK compliance with that then? I don't know if Midwives are "compelled by law to force women to accept family planning advice"? I can't imagine that the NHS or the NMC or the RCM would have anything as aggressive as that written into their policies/rules/regulations - forcing someone to do something is very dodgy territory. Where did you read that MrsCakes?

Also, I owe an apology to mignonette, I thought it was she who couldn't access the link, but on reading back I realise it was MrsCakes instead.

Gobbolinothewitchscat Sun 23-Feb-14 21:53:00

No! Midwives are not compelled by law. There is no law! It's guidance from the WHO. That is not law - either domestic or EU.

That was cakes and my very point.

So - for the avoidance of doubt - no midwife in the UK is required by law to provide family planning advice. So please don't tell patients that.

the WHO advising the EU that Midwives should provide family planning advice

No, I think it is the WHO advising that MWs should be properly trained to be able to give family planning advice if their patients ask for information on the subject.

It is you who keep suggesting that MWs are bound by some sort of regulation to dispense unwanted contraceptive advice. Notice that I said they are not compelled by law.

missismac Sun 23-Feb-14 22:06:28

Gobbolino I'm sure a Midwife mentor would put me right before I could have 'totally professionally' embarrassed myself or mislead any woman (Midwives don't have patients) about the fact that the EU requires (or doesn't) Midwives to ask women about their thoughts on contraception. It's OK to make mistakes, it's part of the human condition and how we move forward as individuals and as a society. Most people recognise that. It's especially OK as a student, as long as one learns from it and tries not repeat the same mistake. It's not OK to pick on small mistakes made by others & blow them up out of proportion to try to make that person look foolish, and It seems that's what you are trying to do to me here.

I asked what the evidence base was for the advice you were given about family spacing because, as I said, it doesn't tally with any advice or research that I've been able to find, and I was, and am, interested to learn. Your reply implies that the information I have is misguided because your friend was told the same thing as you. Again, you have not been kind or helpful. A simple "I don't know" would suffice.

I seem to have annoyed you somehow, but I've already apologised for whatever misdemeanour you feel I may have committed way up-thread. So please can you try to reply without sarcasm or attempts to belittle me. If you find you can't then please let me be.

missismac Sun 23-Feb-14 22:11:27

No, I don't think I ever said a Midwife was required by law to provide family planning advice? You've misread, or misunderstood.

I thought that they were required by an EU regulation - I'm still not certain that that isn't the case - and I thought that the link I provided was to the right bit of documentation, but you have both put me very firmly right on that. For that I Thankyou both. But then why do Midwives have to ask that question? There must be a reason.

Presumably in an effort to prompt women to consider their contraceptive choices so that they are not taken by surprise with an unplanned pregnancy.

Gobbolinothewitchscat Sun 23-Feb-14 22:22:08

It's not a small mistake - it's the kind of thing that could cause you problems further down the line with your professional body if you told women or patients or whatever you call them that. My DH is a dentist and generally pretty sanguine about things and even he was shock. It's a blooper - and that's fine - but there needs to be insight into the fact that it is. Rather than defensive minimising. As I said before, I really swithered about posting again but, on balance, felt I had to because I really don't like the thought of a vulnerable woman who feels uncomfortable enough already being told that it's a legal requirement that she discuss contraception with you - you must see how upsetting and opressive that could be?

I'm not trying to make you look foolish - but I have had to post the same thing about 3 times. As have other posters.

I'm not going to simply say, "I don't know" to you re the spacing without explanation because a key point is that two consultants in a large Manchester teaching hospital seem to share the same views. So that indicates that there is a school of thought (quite a well qualified one - and that is a matter if fact) that doesn't agree with what you've been told or researched.

missismac Sun 23-Feb-14 22:22:28

Yes that too, but I mean some kind of regulatory reason. The questions that midwives 'have' to ask - are required to ask - are usually due to NICE, RCM, NMC, WHO or whatever, guidance. Off to look harder.

I think that 36 weeks is a much better time to say something like "it is possible to get pregnant 3 weeks after giving birth, have you considered what type of contraception you will use after your baby arrives?" than to say it after the baby arrives. If, as I did, you have what one consultant described as a "semtex suppository birth" then being asked what type of contraception I would be using shortly after that birth would be insensitive to say the least. I had a shredded fanjo. That was all the contraception I needed for the months that it took to heal.

To ask about contraception after that kind of birth would imply that the MW had no idea about the birth/complications I had. And given that every one of the 4 community MW who contacted me after I had my DD insisted on asking me the same questions about it (did none of them take notes?), I got the distinct impression that they hadn't a clue about what it was like to have considerable complications after birth. They just discharge you after 2 weeks and never see the women again who are too traumatised to have another child.

Gobbolinothewitchscat Sun 23-Feb-14 22:27:04

An EU Regulation is law. So if you think that midwives are required to ask about contraception by way of an EU Regulation, then what you are saying is that there is an EU law which requires you to do that. Which is not correct.

That is why posters think that you think that you are legally required to do it. That is not correct.

We have not misread or misunderstood.

MrsTittleMouse Sun 23-Feb-14 22:32:45

Before birth is better. I was massively pissed off after my first delivery that so much time was taken in box ticking like contraception when what I really needed was help with painful scarring - no box to tick so no help at all, and over a year in pain (until the second delivery and at last managed to get a decent gynae to sort me out - all through my bloody efforts and pretty much at the stage where I refused to leave the examination room until I got a second opinion). It was so obvious that I didn't matter as a patient at all, and they couldn't have given a stuff whether I actually needed help with contraception as long as I could be pushed quickly through the conveyor belt.

MoominIsWaitingToMeetHerMiniMe Sun 23-Feb-14 22:35:40

As someone who had an unplanned pregnancy and - despite being halfway through a degree, before anyone puts it down to a lack of education - will happily admit I've been completely lax with contraception in the past due to being completely incapable of remembering to take a pill even with an alarm set on my phone hmm I'll be so appreciative if the midwife will chat to me about contraception - I'm lucky to have one community mw I've seen all throughout my pregnancy so far. I feel I can trust her, and let's face it - she knows my medical history, I've told her about stuff coming out of my vagina, a chat about contraception is hardly 'intrusive'.

I have no idea when I can re-start contraception, what sort will affect the baby, if I can breastfeed or not - and although I'm very internet-savvy and more so than most even my age, I'd rather hear about it from a trained midwife with real-life experience than Doctor Google.

HarderToKidnap Sun 23-Feb-14 22:41:32

I have to ask before discharging a woman into the care of the HV, I'm a community midwife half the time (other half MLU so don't have to ask then). I hate asking this question, in fact I hate all the routine "intrusive" questions, but especially this one when faced with a whey faced, wincey-sitting new mother who will already have been asked the question when discharged from hospital. I've developed it into a little joke which basically goes "so do you understand now how babies are made?" Which they laugh at and then I do a quick spiel about could get pregnant within the first few weeks, GP will discuss contraception with them at their 6 week check, see GP sooner if you want something sooner, and then move on. From my POV, I'd much rather chat about it antenatally. I agree with a PP that when you are talking to a woman with awful birth injuries, it seems terribly insensitive, and yet I always fear the one woman I don't mention it to will be the one who gets pregnant because she thought she couldn't so soon after birth. Having a TOP or continuing with an unwanted pregnancy could be catastrophic for a woman, potentially life ruining, whereas a very quick chat about contraception never will be.

missismac Sun 23-Feb-14 23:04:24

I didn't said anything about a woman having to discuss though - I said that the Midwife had to ask. That's a different thing.

And no, it's not a 'massive blooper'. The defensive minimising thing is clever because now if I disagree or stick up for myself then it looks like that's what I'm doing, but I really, really dislike bullying so I can't let that stand and have to correct you on it. It was a genuine mistake that cakes put me right on - as I said that's what being a student is about.

In perspective - no minimising: my mistake was thinking Midwives had to ask a question because EU regulations said they did. I was wrong the document doesn't say that, so maybe Midwives don't. I'm not a lawyer so I didn't know that regulations and law were one and the same. You are a lawyer you do know that - maybe cut people who aren't Lawyers some slack? But I do know now (Thankyou) and that's another mistake I won't make again. The mistake wasn't world/life/care changing so please stop trying to make out that it is. I'm always happy to be corrected and to learn, but I'm not happy to be jumped all over for a mistake I have held up my hands to.

If you have post the same thing three times it's because you're not listening. When asked about the EU regulation the first time I immediately put up a link. As soon as cakes came on to say it wasn't a regulation I held up my hands to my mistake. Again you are using exaggeration to make it appear that I was more than wrong - that I was stupid. That's not right or kind.

I started the thread to gauge opinion on women's views of whether they would prefer contraception discussed antenatally/postnatally or not with a midwife at all. the debate's been great, lots of people have commented and the thread's been really informative, but you have been on my case and unpleasant since the first page. I know you don't like 'some' Midwives - or me, you've made that abundantly clear, but please don't take your personal feelings out on me. Yes, I made a mistake about a document. Yes, that's your trade so you were happy to point it out. No it wasn't massive in the grand scheme of things, I held up my hands to it. Enough now please gobbolino. Let it drop.

WinterDrawsOff Sun 23-Feb-14 23:27:12

So - MW's are not required by law to ask about contraception? Have I got that right?

missismac Sun 23-Feb-14 23:36:03

I don't know - I thought they were, but I was getting WHO advice to the EU confused with EU regulation, which is (as I now know) the same as law and I was wrong. So I don't think they do have to ask? Maybe it's a hospital trust thing? If it's in the Trust protocol then they have to ask it?

HarderToKidnap Sun 23-Feb-14 23:38:50

Well, it's never going to be tested is it, so a bit irrelevant? It's certainly within the code of standards for pre reg midwifery education, published by the NMC, which is is the regulatory body. So could be argues that providing advice on contraception is within the expected remit of the midwife.

Let's say I didn't mention contraception to a woman I was discharging and she came to be pregnant quickly after giving birth. Would she have grounds to complain that I didn't provide said advice, and could that complaint lead to disciplinary action by the NMC? It's not been tested, so I can't be sure. I would guess that yes, she could complain, as the code for education clearly states this is within the role of the midwife, and my hospitals policy is that we do ask prior to discharge. Not following policy without good sound documentation and discussion with the woman generally leads to disciplinary action. Not following the Code, i.e. Not demonstrating a knowledge of contraception and providing relevant advice during the training period, means you won't qualify which could then lead on to the expectation that this advice should always be provided. I'm not sure how regulatory bodies fit within the law, but of there is a chance I could be stripped my PIN then that is close enough for me.

But basically, I mention contraception because I wouldn't want even one TOP or unwanted pregnancy happening because of my failure to mention.

WaxyDaisy Sun 23-Feb-14 23:44:25

In theory discussing this antenatally is fine (though you wouldn't get any engagement from me other than a brief 'yes thanks'). However, in practice I only had 5 antenatal appointments last time (4th baby), and saw 4 different midwives. I felt I had every little time even to talk about the planned birth (homebirth, so one of them would be attending me, so v relevant). I would have been monumentally pissed off at more of those precious appointment minutes being wasted on irrelevant shit rather than what I actually needed to talk to them about.

Gobbolinothewitchscat Sun 23-Feb-14 23:47:03

It is notbullying to point out when you have made a mistake.

Anyway, to put us all out of our misery, a 10 second google search has revealed that, in all probability, it is NICE guidelines determining when midwives discuss contraception (see specifically para 1.2.58)

MinesAPintOfTea Mon 24-Feb-14 07:03:55

There are a couple of issues here. Firstly this project is presumably looking at the evidence base for this policy not the legal basis or the opinions of a self-selecting group of women. This is presumably training in assessing the peer reviewed research in case you end up in a decision-making role later on.

Secondly if you start a thread like this appearing to be a qualified professional it is both probably unethical unless you're very careful and you shouldn't complain about people treating you robustly. You will get far worse from patients.

missismac Mon 24-Feb-14 07:53:36

I never presented myself as a qualified professional in any way Mines. I'm not, and have never suggested that I am.

It's not the pointing out Gob, I've said I don't mind that at all - i welcome it: it's the manner in which you do it and the misrepresentation of what I have/haven't said.

I think it's been an interesting thread miss - thanks for raising some of these issues thanks Hopefully helpful to all

blueshoes Mon 24-Feb-14 10:12:57

missi, yes, the legalbods on this thread have been direct. But you need to get over it. The best way to get someone off your back is just to acknowledge you were mistaken, you have learnt and move on. Don't minimise or give excuses. Say the reason once if you need to but then just leave it.

If you also insist people have to temper the way they give you the message, you need to think about how much worse it will be when you are in front of emotional women with real life issues and whether you are cut out for dealing with the general public when you pose awkward and intrusive questions to them.

You don't have to follow any of this advice. You are entitled to say whatever you like online and in RL. We all make mistakes. This is just a friendly piece of advice about managing people.

HarderToKidnap Mon 24-Feb-14 10:31:12

Yes, missi, without going on the attack I'd respectfully say you come across as a bit precious and thin skinned here, standing on your dignity about how people tell you you've made a mistake. If you've made a mistake, it's not anyone's job to be gentle with you about it, except perhaps your lecturers and mentors. The general public can tell you, as a person in a position with responsibility for aspects of their health, as robustly as they like!

higgle Mon 24-Feb-14 10:38:29

It seems to me that the one time this could be dealt with without the risk of offending anyone would be as part of school sex and relationship education and human biology. It becomes part of the over riding message that any intercourse at any time could result in a pregnancy.

I see why you'd want to make a joke of it in the early days after birth Harder but not everyone has the same sense of humour?

As it took me a year of ttc dd that might affect how I'd feel about being asked "So, do you understand now how babies are made?"

I do think that unfortunately with most of these routine tick box things there is a danger of not being personal enough to the individual woman and her circumstances, and some may find the approach patronising I feel.

I think more autonomy should be given to the midwife to develop her relationship with the woman, and provide suitable, individual advice as needed.

Another midwife upthread said she put "undecided" (for woman's contraceptive choice) as computer wouldn't enable her to make an individual comment or say "not discussed"

So, I think the system needs to be more flexible, to support the best relationship between the woman and her MW's.

HarderToKidnap Mon 24-Feb-14 10:54:09

Don't worry juggling, I'm pretty good at assessing situations. Obviously if me and the woman weren't getting on well, we had a humour mismatch or I wasn't totally sure of my audience I wouldn't joke about it. What I was trying to convey is that I'm very casual about it. It's mentioned but as an aside, and I pick up cues to see if the woman wants to discuss it further. Few do.

I'm sure you are HarderToKidnap and in reality take a more individual approach.
I only picked up on it because I think such an individual approach is so important, and it seems some of the tick box style systems that may be in place in some settings don't really facilitate this?

HarderToKidnap Mon 24-Feb-14 11:46:05

Of course you're right, it is so hard though when you are seeing so many women, many for the first time, you don't know them. Someone unthread said it very succinctly... We have a the NHS, a huge institution, with thousands of employees caring for millions of people. It's just not posisble to provide truly individualised care within this model, or I can't think how to do it anyway. And a lot of of it is driven by litigation, so much of our paperwork has moved over to literal tick boxes, for everything. It's a quick an easy way to show everything has been covered, and cover our arses! But it encourages flippant routine care. V difficult.

It seems to me that one of the biggest problems with the "treat every woman as an individual" is the lack of continuity of care. I saw (as a conservative estimate) about 5 different community MW, 4 on the antenatal ward, 4 during an 8 hour labour and another 4 on the postnatal ward. These MW must also see hundreds of women a year. You can't really develop a relationship in these circumstances. MW obviously need time off and holidays. But even in our local community MW team, when appointment dates can be a bit flexible to work with an individual MW's schedule, no attempt was made to assign a woman a named MW who could develop a meaningful relationship.

VivaLeBeaver Mon 24-Feb-14 12:49:54

I do think things will change in maternity services in the near future. Outsourcing is coming as the NHS is being privatised by stealth.

Companies such as One To One on the Wirral are offering a different type of service where there is more continuity of care.

Part of me dreads it because the socialist in me can't bare the thought of private companies offering such services. However it seems to be working and if it provides a better service then we need to embrace it. I just can't understand how a private company can offer a better service at what must be a lower cost for the commissioning group to buy it.

One of my midwifery friends has spoken to me about trying to set up a business locally to bid for antenatal care/services in the local area. While part of me is excited about such an opportunity I have no business head at all and would be clueless so don't think I will.

Yes, breatheslowly I remember being told "oh, we're a team, we all have the same approach" or something. Not the same as being able to develop a meaningful relationship with a named MW though is it?
And harder to accept with DC2 as when having DC1 there was a named MW system in place (in other London hospital - out in the stix for DC2 smile)

MinesAPintOfTea Mon 24-Feb-14 13:49:12

You communicated in a fashion that implied you were a midwife and didn't mention you were a student until about post 100 (I view all threads on one page). Its not just explicit communication, its what you lead people to infer that they will respond to. Especially when you suggest you are doing research into a topic close to people's hearts.

I think that the main problem is that the midwives either need to be interchangeable individuals who provide care for you at that moment with the problem you want them to, or someone who you build a relationship with and therefore will be more comfortable with making recommendations outside the scope of what you think you have been referred to them for.

At the moment the NHS is trying to have it both ways: save money on the care by not planning a named MW system but capitalise on a care-giving relationship for wider preventative health purposes.

Meglet Mon 24-Feb-14 14:01:03

Before the birth would have been fine.

I knew it all anyway as I read the books, but I wouldn't have been at all offended by a 'box ticking' blanket coverage approach.

Some women wouldn't realise they can get pregnant so soon after birth. I wouldn't take an I'm all right jack approach and deny others the chance to be told.

LittleBearPad Mon 24-Feb-14 16:54:03

I didn't think thr OP was a midwife. She certainly didn't say she was in her OP or anywhere else.

eurochick Mon 24-Feb-14 16:59:58

I've never received or required any advice on contraception and managed not to get up the duff until 37. I'd be pretty offended that just because I have pushed a baby through my foof I am suddenly deemed incapable of deciding these things for myself without professional advice.

But I do understand that some people will need advice.

missismac Mon 24-Feb-14 22:43:54

Thankyou everyone, it's certainly raised some interesting issues and opinions which has given me pause for thought and set me really thinking about the role of the Midwife in public health and contraceptive advice. It seems that most of the midwives I've spoken to see it as offering a woman the opportunity to ask for information if they want it, rather than offering the advice itself IYSWIM. Like opening a door for a woman to go through if she wanted or walk on by if she didn't want or need it. 'Advice' might be something of a loaded term in this context.

I probably was being a bit thin-skinned upthread. I don't mind being called to account, & I don't need gentling (usually). Direct is good, but I can't bear sarcasm, belittling, or attributing wrong words or making them into a different meaning to try to make someone look small. There's no need & it's just wrong. Using language & tone to make someone feel small is unnecessary. I'd pick up on bullying behaviour if I witnessed it happen to someone else, so I sure as anything was't going to back down when it happened to me.

I am the same in RL. I can take emotional responses to stressful situations, and I can cope with anger, swearing, distress, and so on. I actually have a lot of patience generally, especially with people in acutely stressful situations, but I don't tolerate bullying. I guess everyone has their achilles heel, and that's mine, that's my thin skin. In real life that's when I would have to walk away - somehow that's harder online. Especially because I wanted to see what other people were posting about the thread topic. It's a horrible feeling to go to your laptop feeling a bit sick with dread at what you'll find there.

Viva, is that Neighbourhood Midwives. I know they are keen to try to get up & running where I am & do something similar to one-to-one in the Wirral by eventually getting NHS contracts. I hope they do it.

missismac Mon 24-Feb-14 22:48:02

I've just noticed that the thread's been moved to media/non member requests? I'm definitely NOT media (that's actually a bit laughable considering how long it takes me to write anything at all and my aversion to the 'phone), and I definitely AM a member (for many years) so I'm not sure what's happened there?

Gobbolinothewitchscat Tue 25-Feb-14 06:46:37

No one attributed "wrong words" to you or "bullied" you. You did not understand what you were saying/writing and continued despite various explanations to misunderstand/misstate the position, whilst minimising the mistake and accusing people of "bullying" you and being mistaken or misrepresenting you. In fact, at one point, you said the other posters and me were mistaken. As I said up thread, I'd rather you felt "bullied" than you were telling women that they were legally required to discuss contraception with you.

Honestly, I find it really worrying that you think that your rather over sensitive feelings should be put before the best interests of the women you treat. If you or any midwife were making mistakes with my birth and didnt understand what another midwife or doctor were saying to correct that, or were actually telling them (when they knew what they were talking about) were wrong despite various repeated explanations, I'd far rather they "bullied" you in terms of tone or content of delivery than let something awful happen to a mother and baby to spare your feelings.

I'm wondering if you've ever been in a clinical environment - particularly in an emergency setting - it's very robust. I've had an anaesthetist shout at a student midwife for putting essential oils on my back to relax me just before I was taken to theatre for an emergency forceps delivery - which she knew was happening - and he needed to give me a spinal. And my back was now covered in essential oils

I'm sure the midwife had the best of intentions but he then had to spend 10 minutes painstakingly but franticly cleaning my back - in an emergency- with another two midwives

Yes - it was a "mistake". But I completely understand why he was pissed off and wanted to make sure it didn't happen again. I suspect that student midwife wouldn't have got anywhere if she later complained thereafter that he'd "bullied" her.

I know you won't listen to what I have to say as you think I'm "nasty" but please take the good advice up the thread about dealing with situations like this. And, also, I hope you find the NICE guidelines that I found helpful.

VivaLeBeaver Tue 25-Feb-14 07:35:26

Missi, No not Neighbourhood Midwives. It's just a few midwives discussing doing it but don't even have a name/don't offer anything at the moment.

Mignonette Tue 25-Feb-14 10:11:18

I think also, the assumption that women all want to 'build a relationship' too. Many of us don't. We want a professional, swift and boundaried service and don't see the birth as the being and end either.

Far too much fuss is made of 'The Birth' and not enough emphasis upon everything that follows. No wonder so many women are left feeling that some aspect of it didn't match up to their plans. Even when the care was exemplary.

Was it just me or did last nights MW's on OBEM come across as a right old camera aware self important lot? Not something I noticed on many of the previous series.

missismac Tue 25-Feb-14 19:53:11

Migionette I haven't seen last night's OBEM yet - will keep my eye out for camera loving Midwives when I watch it. You're right, there are some (many?) women for whom it's not important to have a relationship with their Midwife. I would imagine that for those women the standard NHS 'you-get-who-ever-'s-on-shift-that-day' care would work well? But do you think that it would be helpful to have more consistency of care from a Midwife postnatally? i.e a 'named' midwife so you are always seeing the same one or two?

Gob:I never said/would say that women were legally required to discuss contraceptive with anyone.

You're still misattributing words to me. Please stop it now.

Mignonette Tue 25-Feb-14 20:12:04

I can only speak personally and It didn't bother me if I knew any of my midwives before, during and after. As long as they read my notes smile and listened then that was good enough for me. The rapport is in the working relationship to the same end- a safe and efficient delivery and more emphasis on what comes after- breastfeeding, pelvic floor care, mental health knowledge. Most definitely MH knowledge- midwifery is VERY poor at this and more MWs need to focus their CPD on learning about it. My stepdaughters textbooks contain less than a page on PND and other MH issues.

I can understand why some women like the continuity of care but for me (again) all I want is consistency and accuracy of advice and practice. Get that right and it matters less who is delivering it.

Another issue I have had to address in the past is the lack of knowledge re drug use and its effects on the child (and Mother). I have been frasnkly astonished at the misinformation, assumption and prejudice of some MWs and other related HCPs. Please use the evidence base. Not all substances cause physical withdrawal yet many MWs I have met have trotted this out without having any accurate knowledge- this especially in more provincial hospitals where I suppose they feel they don't need to know about it.

Gobbolinothewitchscat Tue 25-Feb-14 20:34:26

Missis - you did. For the reasons set out above

Anyway - the good thing is that this thread is here and should be searchable for any other posters who are similarly misinformed on this by their midwives.

Hopefully that won't be the case and this is just a student aberration confused

mrsbug Tue 25-Feb-14 21:37:34

missis, unlike mignon I would have loved to have seen the same midwife throughout. I saw the same midwife for all of my antenatal appointments, apart from one, when she was on holiday. That was great as I did feel like I trusted her and she knew my medical history. It was a factor in me opting for a home birth, I wanted to give birth in familiar surroundings with a familiar midwife (I was told that'my' midwife would attend the birth if possible, if she was on call and not at another birth).

As it was I ended up in hospital with a number of different midwives (long labour), then I was visited by a different midwife each time I had a home visit. I found it quite unsettling tbh. No logical reason for this, I think I just find it easier to talk about personal with a familiar person.

Mignonette Tue 25-Feb-14 21:48:12

Gobbolo

I think you are being a little but hard on her by intimating malfeasance and a little pompous too.

Mrsbug

Yes I can only speak for myself and that maybe I might not be alone in my thoughts. I am aware that it is an important relationship for many women though smile and that for a home birth especially, that relationship needs to be one of familiarity and trust.

LittleBearPad Wed 26-Feb-14 00:16:11

Gobbolino you aren't in court. You're being overly dramatic.

Mignonette Wed 26-Feb-14 07:44:13

It is upsetting to hear somebody say they feel a bit sick with dread about what they will read on their own thread.

And citing an episode of inappropriate communication in a theatre as something that HCPs should 'get used to' is not good professional 'advice'. The best and most professional HCPs don't use shouting to communicate urgency.

I can assure you of that and I, like many of the posters on here have a great deal more experience of health care environments and their staff than you do.

Honsandrevels Wed 26-Feb-14 13:12:48

I find it hard to understand the mindset of people who find it patronising to be asked about contraception by a midwife. It may not be relevant to you but it may help others. Surely it is similar to the domestic violence question at booking in? Not relevant to many but it is there to help those who may be in need of help or advice.

There are young women, women with learning disabilities, those who may be unaware of heightened fertility post pregnancy. It is better to ask everyone than miss someone who may be vulnerable or misinformed.

higgle Wed 26-Feb-14 13:36:20

I find it hard to understand how, in the underpaid, over worked world of social care we are expected to treat our service users as individuals, deliver person centred care and to tailor our services to offer the minimum of support required to support independence. In the NHS, which should be run according to the same principles, anyone with half a brain is supposed to accept being treated as if totally lacking in intelligence common sense or gumption just to ensure the old one size fits all can be doled out.

I was very fortunate to be able to have a straightforward (if lengthy ) first labour at Lizzy and Johns with Yheudi Gordon and his team. They were the gold standard of patient care and certainly would not have raised any questions that were unwelcome. I was never asked about DV and would have complained if I had been. Also continuity of care is not the same thing as continuity of carer, if you can't offer the second you really should be working your hardest to offer the first.

HolidayArmadillo Wed 26-Feb-14 16:48:25

You would have complained had you been asked if you were in an abusive relationship? I can only hope you never are, because it doesn't just happen to other people you know, it happens to people like you, people from all walks of life and if I can just help one person by asking the question and them trusting me enough to disclose, then I'll ask everyone a hundred times.

StarlightMcKingsThree Wed 26-Feb-14 19:56:11

I don't like it being raised at all.

Why then particularly? It all seems a bit random. Presumably those who were unsure how babies were made become pretty aware by that stage.

I always say that I'm breastfeeding and will be relying on that and then dare them to try and tell me it isn't reliable.

VivaLeBeaver Wed 26-Feb-14 19:58:51

Higgle, why would you complain if you'd been asked about domestic abuse? 1 in 4 women experience it including naice women who can afford private care.

StarlightMcKingsThree Wed 26-Feb-14 20:01:41

'Those of you who feel capable of making their own contraceptive decisions, that's great but there are women who may not have thought about it or women who don't know all the options and age isn't an indicator'

That may be true but what is it about pregnant or postnatal women that make it alright to treat them as sitting ducks?

Women (general) who haven't given birth or be just about to are just as capable of having babies.

I find the discussion intrusive and inappropriate.

VivaLeBeaver Wed 26-Feb-14 20:05:19

<bangs head on desk>

Because there are a lot of old wives tales about conception after childbirth which a lot of people believe therefore it is the right time to make sure women are well informed of their options. Plus contraception which they may have used for years may not be suitable if they're breastfeeding.

Like has previously been said on this thread MNers are not typical of the general population. We all by default have Internet access and in general are fairly well informed, articulate lot. Not everyone is.

StarlightMcKingsThree Wed 26-Feb-14 20:25:56

'I'm supposed to ask them specifically what method of contraception they're planning to use and enter that on the computer system. Why I have no idea.'

Blimey. I have been asked twice. I say 'breastfeeding'. They say it isn't reliable and I say it is as reliable as the pill if you do it properly. Then they look confused and say not to be surprised if another baby pops up. At that point I smile and nod but what I really want to say is I'm going to write to your manager and suggest your team gets some decent breastfeeding training.

StarlightMcKingsThree Wed 26-Feb-14 20:28:11

But Viva I wouldn't have a problem with the way you say you bring it up.

A leaflet. Ask if there is anything you can help with etc.

You know I like Boffin's idea. Much better. A leaflet with the scientific details of what contraception might have been affected by the pregnancy and birth process. That seems more relevant.

StarlightMcKingsThree Wed 26-Feb-14 20:29:13

Viva Is there a study that shows an increase in unwanted pregnancies in regions or groups of women that don't have to face the contraception question?

StarlightMcKingsThree Wed 26-Feb-14 20:45:30

Viva I prefer 'caesarean birth' to section.

VivaLeBeaver Wed 26-Feb-14 20:49:13

Well if you told me breastfeeding I'd be really pleased as I know its 99% effective. I'd maybe ask you if you were aware not to give top ups.

A leaflet on its own probably isn't any use as how many leaflets do you get given? I've been inspecting another hospital today and I asked some women there did they they know about X subject. None of them had heard of it and felt it would have been good if they did.....they all get given a leaflet on it. People don't read leaflets. Some may, but not everyone. They have other pressures in their lives.

I have no idea if a study has even been done on unwanted pregnancies in other areas. Afaik everywhere in the uk would ask so any studies would have to compare the uk to other countries so probably wouldn't be very valid.

The nhs does practice defensively. You can guarantee if someone got pregnant 6 weeks after giving birth and said they thought they couldn't getp as their periods hadn't resumed. If they said they hadn't been warned and sued the hospital they'd probably be successful.

SaucyJack Wed 26-Feb-14 20:50:52

I might just reply with "anal" if anyone asks me on the post-natal ward this time.

VivaLeBeaver Wed 26-Feb-14 20:51:38

Starlight. I always write it as lscs on paperwork as that's quickest. I refer to it as "caesarean" when talking to a woman. But tend to write section on MN as always thing lscs might be a bit medical jargon.

VivaLeBeaver Wed 26-Feb-14 20:52:33

I'd love it if someone did say anal. I could then maybe tell matron that we needed it adding as an option on the computer drop down list! grin

StarlightMcKingsThree Wed 26-Feb-14 20:57:14

Course you do Viva. I probably learned all about the contraceptive effects of breastfeeding from you way back.

But no-one else that I met did. No MW nor HV nor GP and they all looked at me as if I was ignorant or some kind of irresponsible hippy.

The truth was with each of my 3 planned kids in the first 5 months I never went more than about 90 minutes without feeding 24/7. In fact I stopped bfing my first in order TO get pregnant.

StarlightMcKingsThree Wed 26-Feb-14 20:59:04

I guess with bfing, you can always increase prevention further by adding another form of contraception!?

Who knows? I wish HCPs were more up to speed on this though I think true complete baby-led feeding is rare so maybe not a funding priority.

VivaLeBeaver Wed 26-Feb-14 21:02:48

Most women look at me hmm if I mention breastfeeding as contraception. In fact I don't mention it anymore! Partly because I haven't worked on the postnatal ward for ages but also because it really didnt seem like anyone believed me. grin

blueshoes Wed 26-Feb-14 22:45:40

Viva: "The nhs does practice defensively. You can guarantee if someone got pregnant 6 weeks after giving birth and said they thought they couldn't getp as their periods hadn't resumed. If they said they hadn't been warned and sued the hospital they'd probably be successful."

Why would anyone dream of suing the NHS if they got pregnant before their first period and if they were idiotic enough to do so, what is your basis for saying they would probably be successful?

Personally, I think they would be laughed out of court for bringing a frivolous and vexatious case.

VivaLeBeaver Wed 26-Feb-14 23:05:13

They'd say that a health professional should have warned them.

I dunno, I'd like to think it wouldn't happen.

However I know a case where a clinically obese lady requested an epidural in labour. Epidural was sited and 60 minutes later on her first pressure area check there was already a pressure sore. Now because of the time scale when this was found it can't have been due to negligent care of her been left for hours and hours in the same position. Care was put into place of keeping off the area as much as possible, tissue viability nurse came, dressings applied, district nurse when back home. So everything done.

She sued. The hospital settled for 8k as its cheaper than going to court.

blueshoes Wed 26-Feb-14 23:28:07

Viva, to sue a hospital/midwife for professional negligence, the woman has to prove in a court of law that the hospital owes her a duty of care to warn her. This is not something that is established willy nilly because someone got a bee in their bonnet and hoping to squeeze some money out of bringing an opportunistic claim.

The case you cite has nothing to do with a woman falling pregnant and even if it did, it does not set any form of legal precedent because it never went to court and ended up being settled.

If you are a midwife, I accept you are not legally trained to understand the nuances. However, I think you should be careful about what you say about the legal position and be clear in your mind as to what you know is "the law" and what is your opinion.

VivaLeBeaver Thu 27-Feb-14 06:36:04

No you're right it is my opinion and I never said I'd had any sort of legal training. I don't think I've ever said anything about the legal position of offering advice.

But I do know that people sue hospitals a lot for stuff which I find unbelievable. And I know that hospitals settle a lot of claims rather then fight them in court.

HolidayArmadillo Thu 27-Feb-14 07:57:15

Yep, our hospital settled on something there was documented evidence of before she set foot on delivery suite, crazy? Yep. But cheaper than a court case. I agree with Viva that given the right woman and the right hospital someone could make a case and probably get a pay off.

LittleBearPad Thu 27-Feb-14 08:49:26

There seem to be a lot of frustrated lawyers on this thread. I don't think Viva recounted her story as a legal precedent. And let's face it a lot of hospitals will settle rather than defend a claim. On the face of it, settling is cheaper but they are still out of pocket

Mignonette Thu 27-Feb-14 08:52:33

I agree Little

MN does provide a Lincoln for a lot of lawyers!

higgle Thu 27-Feb-14 15:18:25

I'd mind because the implication would be that I could be the sort of person who would put up with this, and that I needed someone else to help me. It would imply that I was too stupid, weak or lacking in self esteem to pick up the phone and report it. I just hate this whole idea that women need to be prompted, asked, patronised and condescended to because they can't be relied upon to do sensible things like organise contraception or disassociate themselves from violent men.

VivaLeBeaver Thu 27-Feb-14 15:32:45

That is one of the saddest judgements concerning women experiencing domestic abuse that I've read. sad

Mignonette Thu 27-Feb-14 15:35:46

Higgle.

That is a terrible thing to say. I wasn't stupid or weak and the act of being brutalised robs you of your self esteem so to have that depicted as a character flaw..... Your statement had me more speechless than when my ex smacked me across the mouth sad

VivaLeBeaver Thu 27-Feb-14 15:40:34

Migonette, 99% of people don't think like Higgle. Don't let it upset you.

One of my good friends is currently experiencing domestic abuse, inc violence. She's one of the bravest, most un stupid people I know.

She will leave one day, I'm sure. And she's slowly moving in that direction but when you have someone who you know will kick off when you leave and you're terrified of him tracking you down and the reaction. Plus worries about money and housing its the most difficult thing.

higgle Thu 27-Feb-14 15:43:28

Well, the fact of the matter is that if anyone hit me ( and an ex boyfriend did slap me across the face man ears ago) they would be straight out of my life and reported to the police ( as I did).
These people would have no power at all if we resolutely stood up to them.

VivaLeBeaver Thu 27-Feb-14 15:45:40

Higgle, if you were married, with kids, no savings and weren't a high flying lawyer can you not see how much harder it would be to leave?

I think its very easy to say you'd still leave in such a situation but when it comes down to it it isn't always easy.

StarlightMcKingsThree Thu 27-Feb-14 15:49:31

Higgle you need RESOURCES to leave an abuser, and one of the first thing an abuser does is strip you of them.

mrsbug Thu 27-Feb-14 15:49:46

higgle well done for leaving your ex, but your comments are victim-blaming and quite offensive.

Mignonette Thu 27-Feb-14 15:54:45

All is clear and simple in Higgle land.

higgle Thu 27-Feb-14 16:23:47

It is clear and simple. Zero tolerance. Last week I had the chair of the charity I sit on the board of removed for bullying a member of staff. I won't tolerate this sort of thing at home and I certainly won't tolerate it in public life. As my lovely DH of 30 years accompanied me to all my visits with both pregnancies I can't see any more reason that I should be asked about DV than he should .

blueshoes Thu 27-Feb-14 16:24:37

One of my bugbears is people not understanding the law and then talking out of their bottom. It is the difference between opinion and fact but people get confused about that as well.

People who claim to be educated should be careful what they cite as the law.

mrsbug Thu 27-Feb-14 16:45:48

Higgle are you saying that victims of domestic violence are partly to blame for putting up with it? shock

Because that's what it sounds like you are saying.

Oh and the reason you are asked about DV and not your DH is because you are the one carrying an unborn baby, and because women are far more likely to be victims of domestic violence than men, and because it's really common for domestic violence to begin when the woman is pregnant.

Mignonette Thu 27-Feb-14 16:47:41

grin at the idea that you can just remove bullies- I moved trust after being bullied out of my position because I blew the whistle on patient abuse.

Not all of us can just 'remove' bullies at will. You don't have a clue my dear.

Mignonette Thu 27-Feb-14 16:48:22

Lincoln Lawyers.

higgle Thu 27-Feb-14 16:52:56

I'm not talking about anyone else, only myself, never a good idea to think you know about other people's lives. I must confess that years ago as a young solicitor going to court to get injunctions for women in DV relationships I was often surprised that they reconciled on the court steps on occasions even when safe and suitable accommodation was arranged. I find the suggestion by others that I as an individual might not be able to stick up for myself quite repugnant. if you were to meet me you would realise that any box ticking questions of this kind would met with a worse than frosty response. I try to pay for health services etc. when I can because then you get treated as an individual and your wishes are respected.

VivaLeBeaver Thu 27-Feb-14 16:56:35

What are Lincoln lawyers?

Mignonette Thu 27-Feb-14 17:07:33

But you were talking about the lives of others because you extrapolated personality, will to change and ability to change things to all people in DV situations.

We all find it repugnant to feel we are not able to defend our own rights. But not everybody has the ability to extricate themselves so slickly and human relationships are complicated things. The will and self direction we possess at the start of a relationship may not be there at the end and we can only make choices if we feel we have them. And they have to be realistic.

Lincoln lawyers have a mainstream defn of lawyer whose private practice is doing so poorly that he goes to extremes to cut costs (such as running his office out of his car. However it can be stretched to cover people who 'practise' online on forums such as this with no guarantees as to quality of recourse.

VivaLeBeaver Thu 27-Feb-14 17:08:12

Ah, I'd not heard the expression before.

higgle Thu 27-Feb-14 19:20:44

"I was wondering how you would feel about"

I think that was the invitation for this thread, and "pretty annoyed" is my response. I'm not here to talk about other people on this thread, only me. If i want to engage in disussion about public policy and matters in the round I'll find another question to answer, thank you.

Mignonette Thu 27-Feb-14 20:28:16

But you did talk about and judge other people. And you cannot even see it.

higgle Thu 27-Feb-14 22:22:54

And you seek to judge me! Quite openly, I haven,t judged you, just put forward what I wasn't from healthcare professionals who deal with me. I don't want a social worker or victim liaison officer I want a highly skilled polite person who does their job well and no more.

Mignonette Thu 27-Feb-14 23:24:06

I'd mind because the implication would be that I could be the sort of person who would put up with this, and that I needed someone else to help me. It would imply that I was too stupid, weak or lacking in self esteem to pick up the phone and report it

You do judge Higgle. it is there in black and bold.

LittleBearPad Fri 28-Feb-14 00:14:29

Higgle I hope that you display mire empathy for your clients than is apparent on this thread.

higgle Fri 28-Feb-14 07:35:57

I don't have "clients" have you not read my posts?

I am asking for the values of personalisation, unique care planning and the acceptance of risks which are the lodestone of good Social Care practice to apply in the health service. I'm not happy that my health care should be provided on the basis that my answers and requirements need to fit into pre written boxes. My own GP is very comfortable with this and knows that I'll come in with some up to date inforamtion on whatever issues I face and want to discuss this with her. I am not happy that people who do not know me make assumptions about me because of my sex. It is the system that implies people may be weak and lacking in self esteem, not me.

HolidayArmadillo Fri 28-Feb-14 08:24:42

The facts speak for themselves, 30% of domestic violence starts in pregnancy. That means a huge amount of women who have never suffered abuse before, will start to do so, by virtue of the fact they are pregnant. Pregnancy can cause vulnerability, financial and housing issues, additional stressors that they have also not experienced, so when abuse starts it is very very easy to become a statistic when it's piled on top of those other worries.pregnant women are vulnerable, or at least they can be, yeah it's a sex thing, because men can't get pregnant. When they can I'll start asking them the same questions.

LittleBearPad Fri 28-Feb-14 08:44:52

I must confess that years ago as a young solicitor

Yes. I have read your posts. Solicitors have clients. Perhaps you are no longer a solicitor.

LittleBearPad Fri 28-Feb-14 08:53:03

And you choose to pay for your personalisation Higgle. Not everyone can do this or wishes to. I certainly didn't want to give birth in a private hospital - I didn't trust them as much as the NHS.
Given the wide range of people the NHS sees inevitably there is a standardised approach. Its patients have massive differences in education, life experience and understanding.

higgle Fri 28-Feb-14 09:54:14

Quite right, LittleBearPad, for the last 7 years I've managed a service for a Charity for older people, that CQC and our local authority rate very highly. I've run two pilot schemes on person centred care and been involved in a project to take the best practice from Health and Social Care and health Service management training into an accredited manager qualification. I'm also the chair of a national charity for older people with specific minority requirements. I practiced as a Solicitor for 20 years and also lectured in law part time.

My service provides funded ( and some private) care on a completely tailor made basis, you can have it for free if you qualify for support on the usual assessments. I don't provide one size fits all for my service users and I don't expect it for myself. Sometimes we have to send care staff into hospitals with service users to ensure their needs are met so I am well placed to judge the quality of services.

It saddens me to hear "inevitability" used as an excuse for inadequacy.
it also saddens me to see that instead of encouraging empowerment and creating role models of strong women who can make their own choices and be assertive there are those for whom a culture of dependency is tolerated, and that is no reflection of the individuals that society is not equipping to cope. It doesn't cost money or take much time to look at people as individuals, it doesn't mean being worried about being a whistleblower to say to your manager or commissioner "had on a minute, we can do this better". There are all sorts of organisations such as Healthwatch where individuals can raise these concerns and demand better, but no it is far easier just to put up with it and have a good old moan.

Mignonette Fri 28-Feb-14 09:59:51

Higgle

You made disparaging assumptions about people who experience DV.

Your claim to offer tailor made 'care' rings a little hollow when your posts on here are so far from demonstrating any compassion and empathy whatsoever- victim blaming non?

And the old 'culture of dependency' argument you put forward as some kind of defence of your attitude is a load of old cobblers.

higgle Fri 28-Feb-14 10:49:03

Oh, Mignonette, once again when someone brings an evidence based response to your single track views you fail to respond. I don't need you to analyse my professional competence, I've plenty of formal proof that I've made a real difference to peoples lives.

I feel your personal history and the difficulties you encountered in trying to do the right thing has coloured your views, and before you descend down the route you have on other threads when people don't agree with post I'll make it very clear that I think that whether we pay for it or not we should receive good, person centred care. I deliver it and I expect it.

(puts on hard hat and waits to be told to "wind my neck in")

Mignonette Fri 28-Feb-14 10:52:29

You are very slippery Higgle. i don't care about your clumsy self aggrandising.

I am addressing your derogatory comments about people who have experienced DV. As have many other posters yet you still cannot see it.

You clearly have no insight or ability to self reflect.

Mignonette Fri 28-Feb-14 10:53:39

And you do not demonstrate person centred care and your very own views evidence that.

higgle Fri 28-Feb-14 11:11:27

So, if I express my personal views on matters pertaining to my own healthcare you feel able to judge me.

if I point out there is empirical evidence of my professional achievements you say you know better. It is always very odd when one poster seems to think they know better than the assessors at my professional institute, my CQC inspector and my service users who rate me very highly, but of course you always know best. A bit of a David Southall perspective really.

Mignonette Fri 28-Feb-14 11:19:32

Trouble is you expressed derogatory and judgemental views about a whole section of society- if you hold opinions such as that privately yet claim to espouse the opposite in your profesisonal life, that makes you appear unauthentic. And clients- certainly the clients I encounter- would be able to tell.

You weren't expressing views on your own health care- you made negative and derogatory comments based upon your perceptions of the kind of women who experience DV and don't immediately kick the person responsible out.

RE personalised health care we are actually singing from the same song sheet, arguing against tick boxes and generic comfort titles!

You can have accolades from your peers showered upon you but sadly that is not the same as being respected by your clients/patients. Some of the lousiest direct care givers in nursing are the best managers and are feted accordingly sad.

What I am saying is that you present in an incongruous manner. You do not sound very caring or empathetic in your own words and that is all I have because ultimately both you and I could be Walter Mitty's on an anonymous forum (although obviously people on MN knowing me IRL reduces the likelihood of that).

higgle Fri 28-Feb-14 11:35:42

So, now you know better than the people I support how good I am at my job? I despair. I'd like to give you their names and addresses to visit and listen to what they have to say about how I tirelessly stand up for their rights, but obviously I can't. Oh well, back to my thread on weddings. I'm clearly not good for anything else.

Mignonette Fri 28-Feb-14 11:50:36

I am going by what you have said on here and you didn't present particularly empathetic and understanding view on DV. That is all we can go on seeing as it is anonymous n all.

Other posters clearly think so too.

Maybe instead of trying to defend your comments about DV, you should drop the defensiveness and give some time as to why others find them unappealing and why they fly in the face of the way you clearly see yourself.

I cannot make it any clearer than that but we'll have to agree to differ before our fingerprints wear away smile.

HarderToKidnap Fri 28-Feb-14 13:45:10

Higgle, I'm a midwife and I'm supposed to ask about DV at booking and at 28 weeks. Can you tell me how I can tell who is a victim of DV just by looking? That would be really useful.

higgle Fri 28-Feb-14 15:25:31

I'm reluctant to comment on this one because my views seem to be so controversial, I think that in part my negative feelings would arise because it would feel like an implication that my DH would be a "suspect" because he is male, and partly because I have very strong views about privacy and interference. I would certainly opt out of the present NHS data gathering exercise and refused to see Health Visitors when DS 1& 2 were little because of central storage of information from red books. I think that the word "Domestic" in relation to violence trivialises it a bit, (e.g. references to "a bit of a domestic" really, it is just straightforward nasty illegality in the same way that a street mugging is. The penalties might be higher if the word was dropped.

BoffinMum Fri 28-Feb-14 16:06:22

Harder, speaking as a victim of DV in a precious relationship, I can't imagine I would have told anyone because I didn't realise I was experiencing it, thanks to my mind having been fucked around with.

And in actual fact, what is anyone going to do about it anyway? Pull the victim out of an emotionally/physically abusive but comparatively cosy home, and dump someone on benefits in a hostel, just when they are about to give birth? And that's if there are hostel places, which a lot of the time there aren't. Clearly when someone might be murdered intervening is a no-brainer, but a lot of the time it's nasty but sub-critical, what goes on.

The harsh reality is that a lot of people put up being knocked about a bit because frankly the alternative is stigma, poverty, insecurity and greater anxiety. That's why it's such a problem. And you can't write a prescription for that.

HarderToKidnap Fri 28-Feb-14 17:42:37

People incredibly experienced in dealing with DV have written the guidelines and decided midwives need to ask the question. This is because it's a pregnancy problem (a third of DV starts in pregnancy) and also because it opens a door. No, I don't expect women to disclose DV to me when we first meet, and in fact only one ever has. A couple more have disclosed further along in the pregnancy. But by asking, you let the woman know that unacceptable, that HCPs are aware it happens and that support is there. It sows a seed, that perhaps it's not OK. That's the theory.

The one woman who did disclose was desperate for me to ask. She was just waiting for someone to ask. She literally grabbed the rope I threw and clung on, sort of realised this might be her last chance and took it. She was referred to SS and received in depth support and counselling from our DV liaison team. She was assigned a WA worker and given one of those special police codes that meant police would attend her house quickly. She left him before she had the baby and was happy in a hostel when we discharged her. I'm an experienced midwife, I have been working in the community for five years on and off and have seen thousands of women, and she's the only one who has disclosed initially and it changed her life. That one woman is worth upsetting a million people like higgle.

missismac Sat 01-Mar-14 22:03:57

Hi everyone, I've just popped back to say 'Thankyou' to everyone who's posted on this lively thread - even Gobolino. I stopped posting because it was getting a bit pantomime - 'oh no I didn't', 'Oh yes you did' between me and Gob and I felt it was unfair on those who had an interest in the topic to continue our bickering on the thread. However you've all given me a lot to think about. Thankyou for sharing your views so generously, and be assured I will never knowingly make the mistake of confusing a regulation, or a law with a recommendation again. ;)

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