I'm a midwife AMA

[Jemima232]

Community Midwife with four children of my own.

Also worked as an Independent Midwife.

Breastfeeding Counsellor and Sleep Consultant.

[WellErrr]

Oooh thanks for this!
I’m starting as a student in September - what are the best/worst parts of the job?

I was really looking forward to it and have obviously worked really hard to get in, but been left feeling really disheartened and deflated, as almost every qualified midwife I’ve spoken to seems to absolutely hate it.

Am I right to be worried!?

Thanks

[Jemima232]

@WellErr

Hi there,

The worst parts of the job are

Unsocial hours

Being called out at night

Poor staffing levels

Endless paperwork

Having to argue with doctors all the time when they refuse home births and force inductions on women who don't need them

and the best parts are

Helping women through a life-shattering experience

Helping new parents as they adjust to life with their baby

Succeeding with breastfeeding problems

Knowing that your skills and empathy can help when things go wrong


I think I have been a little simplistic in some ways but I can expand if you want.

It's the poor levels of staffing which really impact on all HCPs experiences - and on the woman's experience of her labour and post-natal care.

I think there is far too much emphasis placed on ante-natal care. Women need a good deal more support once their babies have arrived than they (generally) do while they're pregnant.

Almost all women prefer to have a midwife who has had a baby herself.

[asdou]

How close was I to losing my baby when I had a placental abruption and a massive bleed?. It stopped, then started again later that day so had an emergency c-section.
I've since heard of 2 women who lost their babies from this exact thing.
Hospital were very lackadaisical initially.

[something2say]

How do you help sexual abuse victims who are ashamed of having internals, let alone lying legs akimbo for hours on end?

[EarlGrayT]

I could think of so many questions I could ask you but I will ask about breastfeeding and sleep.

My one year old is still breastfed to sleep, I am trying to phase this out but it is hard. He still wakes up 3 -4 times in the night and will only go back to sleep when he is fed. Do you have any advice on how I could get him to sleep better?

[Jemima232]

@asdou

You could have lost your baby and your life and were also at risk of post-partum haemorrhage.

The same thing happened to me when I had my first baby, but I was looked after well.

I'm sorry the hospital you went to were lacksadaisical initially. They should have been very pro-active and on the case from the get-go, especially if you had a massive bleed. Did you complain?

[Tolleshunt]

We hear so many reports of women feeling they have been fobbed off by midwives, when they ask for pain relief, such as an epidural.

It seems that some women are coming away from their birth experiences feeling that their wishes have been ignored, that they have been treated with a lack of empathy, and that they have been given the treatment the midwives feel they should have/need, rather than the treatment/pain relief the woman herself wants or needs.

Why do you think this is?

Also, how much of midwives training/CPD covers pain management? Is it generally understood, for example, that pain levels are what the patients say they are, not what the HCP thinks they should be? How does this square with the policy of only allowing paracetamol(!) up to 4cm dilation, for example?

[Stylemebabyonemoretime]

What’s your opinion of sweeps?

[chickhonhoneybabe]

@WellErrr I’m a second year student. I won’t lie it’s going to be tough, the long placement hours, juggling childcare and keeping on top of uni work are a killer! The best advice I can give is to:

• try and keep on top of your uni work, and don’t leave it until the last minute.
  
• talk to your friends about things.
  
• be kind to your self and take time out when needed.
  
• try and eat well and drink plenty whilst on placement.
  
• if you’re struggling speak to your tutors and get an extension for your work.
  
• keep talking....

[ryanreynolds]

I'm 36 weeks pregnant - baby currently measuring big (5lb 3oz on 33 week scan) - I'm worried about going overdue and baby being massive.

DH and I are tall so it's to be expected I guess. No GDD, slightly high BMI which is why extra scans but no concerns at all about it.

My midwife is lovely but just says things like 'nature doesn't give you anything you can't handle'...in your experience is this true or is it just to calm me down?!

Just in case you are my midwife - she's great, it's just this one thing I'm concerned about!

[booksandcaffeine]

No questions but thank you for what you do ♥️

[1sttimeunicorn]

Hello! I had a difficult time having my son 2 years ago (long induction - 3 days, back to back labour, pushed without progress, taken to theatre and given forceps, followed by infection in episiotomy). I'm expecting DC2 in 8 weeks time. I am trying to be as positive as I can, and this time they are saying they are happy not to induce me, but can you offer any reassurance that things will be slightly easier second time around?

[Orchidflower1]

Possible slightly odd question op but something I’m contemplating- have you ever looked after a woman who has become pregnant as the result of a failed sterilisation?
I know there are facts and figures out there etc but just curious as to your personal experience.

[asdou]

Also, I'm not sure whether labour was then induced or whether I went into labour, but somewhere along the day I started labour, but didn't dilate at all, and then the bleeding started again.

[asdou]

No, I didn't complain. I was just grateful to have a baby!

[Jemima232]

@SomethingtoSay

Survivors of sexual abuse need to be cared for with great sensitivity. It isn't always apparent until labour commences that this is part of a woman's past.

An experienced midwife might suspect previous sexual abuse when she attempts to examine the woman.

Also, experienced midwives don't need to do many, if any, vaginal exams in order to assess what's going on. If the woman has confided abuse in the ante-natal period, the midwife should reassure her that nothing will be done without her consent and that it is often possible for labour to be completed without any VEs being done.

If one is needed, however, it is best to do this in a small room, with curtains, and nobody there other than the woman and her birth partner, if she wants him/her there. (She usually does.)

The woman should be offered gas and air to breathe prior to and during the VE. The VE should proceed very slowly and only at the woman's pace.

No woman needs to go through labour with her legs akimbo. Women should walk around and change position during labour (unless they actually want to lie down) and when they are in bed, should always be covered.

If sexual abuse is confided prior to labour, counselling can be suggested if the woman would like it, and a referral made.

[Jemima232]

@OrchidFlower1

Yes, me!

It was my fifteenth pregnancy (don't all gasp - I had a great many miscarriages) and after DH had our fourth live baby, I was sterilised.

Imagine my surprise eight weeks later, to find myself pregnant AGAIN.

So we decided to carry on regardless, as they say. But I had another miscarriage. And never became pregnant again.

So it's more than possible.

I did also look after a lady who had three teenagers and had been sterilised after the third one's birth.

She became pregnant.

With triplets.

[tmh88]

what are the chances of having shoulder dystocia? I had this with my first and this is one of the main things putting me off having another x

[JudgeRindersMinder]

Did having your own babies make any difference to how you approached your job compared To before having your own?
My friend is a very experienced childless midwife and is amazing, she was present when I had my dd

[Jemima232]

@EarlGreyTea

Ha!

Me - with DD1. 14 months, breastfeeding to sleep and waking several times a night until I was demented from sleep deprivation.

I hope not to be shot down in flames but I recommend controlled crying.

If you're consistent it only takes two nights of utter misery. On the third night, they sleep through. You need to pick a night when you're not feeling stressed about anything else, and be ready. Your DP also needs to be on board.

If you actually tackle the feeding to sleep, you may find that your baby won't wake up all those other times in the night. Mine didn't.

But that first night was awful. The second night was better (took an hour and a half to get her down as opposed to three hours the first night) and on night three, I put her down awake and she fell asleep.

I had read Richard Ferber's book about sleep training and it was very helpful.

With my subsequent three DC I made sure they self-soothed from the word go, as far as that is possible.

[ThatCurlyGirl]

No questions but thank you so much for doing the job you do with kindness and empathy - some of my friends have been really affected by traumatic births and I imagine you make the process less awful by being so lovely!x

[Alena92]

Can current or history of vaginismus affect childbirth?
Thanks for everything you do

[Jemima232]

@Tolleshunt

I have ALWAYS given women the pain relief they request, regardless of the stage of labour.

The trouble is that pain can only be felt by the person feeling it, so it's all too easy to make a blanket policy which does not take into consideration the needs of every individual.

I have been accused (by some colleagues) of "giving in" when it comes to pethidine, and using it "too early."

There isn't a "too early." I am not a fan of co-codamol, either.

Labour pain is awful, intense and unrelenting.

I am not sure what to do about this with reference to midwifery education. What midwives learn is one thing. What they are faced with, in terms of hospital policies and staff attitudes, is another thing entirely.

When I had my own first few contractions I remember thinking WTF?? I could not have started dilating but I was in agony. It seemed ridiculous to be in so much pain (I actually had an obstructed labour, but there was no way of knowing that so early.)

Anyway, if a woman is not coping with Entonox, I offer pethidine/morphine/any opiate in the drug cupboard.

It is cruel to allow women to be in pain. And if they want an epidural (and have not previously said they wanted to try to do without one) I arrange it.

I think it's worth finding out what your hospital's policy is on pain relief, before you go into labour.

[Jemima232]

@Stylemebabyonemoretime

Sweeps? Well, they only work if you were about to go into labour anyway. They are also more likely to work in women who have previously had a vaginal delivery, but not always.

I'm not a great fan, if I'm honest, but I don't refuse to do them.

[Jemima232]

@ryanreynolds

The size of the baby does not determine how easy or difficult your labour will be, I promise you. I've delivered many women who have long labours and small babies. My friend, who is a midwife, is just under five feet tall and had a nine pounder. She nearly didn't make it to the labour ward in time, her labour was so fast.

It is the position of the baby in relation to the mother's pelvis that is key. When you're in labour, as long as the head is not posterior (back-to-back) and it is engaged, then labour will be fine a painful few hours but not impossible


Please do not let this keep you awake. I hear it all the time and it is something that is a needless worry.


"The fetal head is the best pelvimeter" is a mantra at the back of every midwife's mind.