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.

@minniecat2406

Delivery of the placenta

There have been lots of posts about this.

In your case, you had the injection and the placenta came out five minutes later.

You said that you were exhausted and could not have delivered it naturally.

In fact, if you had not had the injection, you would have delivered the placenta naturally. It would just have taken longer.

If you are unsure about what happened, request a debrief. It's such a valuable tool.

Thankyou so much Jemima232. You're right, if he had been born in water with nice music and skin to skin I would be worrying that something else I did caused him to have asd.

Could I ask another question? At what point does normal morning sickness become hg and at what point should it be treated, either with meds or iv fluids? Just wondering as it seems to vary between hospitals. I've been told by midwives that as long as I was weeing more than once every 24 hours then I didn't need treatment but I've seen posters on mumsnet saying that they were given anti sickness meds for what I thought was fairly mild symptoms. I suppose it's like pain relief with some hcp's being more keen to prescribe things and others being more in favour of medication being the last resort. It would be nice to know I wasn't being pathetic to be begging for help when I was throwing up 20 times a day and having +2 ketones. I was still keeping sips of water and ice lollies down so I wasn't dehydrated but some relief would have been nice.

BintyBuntyFintyCunty

Lack of Care

Your post made me so angry.

It does reflect the unfortunate fact that there are less staff around at weekends and bank holidays.

It does not in any way excuse the awful care you received. Let's see:

• not made to feel welcome

• being told you weren't in labour when you clearly were

• being denied pain relief

• not communicating what was going on with your baby

• no cup of tea (a gross dereliction of duty IMO)

• not helping you with washing yourself

• leaving you unattended for long periods of time when you needed assistance

I'm sure there were others but that list is shocking in itself.

I would urge you to complain and not let them get away with all this. I am aware of how busy labour ward becomes when there are insufficient staff. But you had a seemingly never-ending series of bad episodes of "care" (I hesitate to call it care in this context - neglect would be nearer the mark.)

I'm both sorry and angry that this happened to you.

elliejjtiny

Hyperemesis Gravidarum

You weren't being pathetic. You were feeling utterly wretched, as who wouldn't be when vomiting persistently.

Over the years I have encountered too many midwives dismissing the suffering of women with HG. I remember one woman was being asked how many times a day she was vomiting (she had been admitted to hospital with incipient kidney failure and had intravenous fluids and four hourly injections for nausea) and the midwife went up to her and started this conversation about how often the woman was vomiting. It went on to how much she was eating and drinking. The whole conversation lasted five or six minutes and the woman was answering as best she could, but vomited four times during this time.

No sympathy at all from this midwife. She then told me (privately) that she didn't believe the woman was as ill as she said she was. This is similar to telling a woman that her pain isn't bad enough to warrant pethidine, for example.

I went back to the patient who was terribly upset and wanted to go home, due to this midwife's attitude. She actually asked me to remove her drip and help her pack, and vomited frequently throughout.

I called our lovely doctor who calmed the patient down and persuaded her to stay. She also tweaked the medication, which improved the symptoms a little.

Three weeks later she started to go into multiple organ failure and had to have a termination in order to save her life.

So no. You are not pathetic and anyone who says you are needs a bloody good slap should be reprimanded severely and given extra training.

JohnnyMcGrathSaysFuckOff

Doctors

Doctors (and midwives) can be very insistent about the way you "should" give birth.

It sounds like the doctors when you were in labour were not open to listening to your choices.

The fact that you went to the bathroom and hid, and delivered your baby yourself is shocking. I really hope that you complained.

Yet again, a birthing debrief would be a good idea, even though your labour happened a good while ago.

You say that it still makes you ragingly angry, even now, so I would urge you, too, to do something pro-active about it.

and

HCPs not having training re-sexual assault patients

This is something that hospitals do have policies about. I have discussed this in previous answers. It was clearly a huge issue for you and your needs were not met, which is disgusting.

Women do need a special level of sensitivity when they are in labour, and even more when they have endured sexual abuse/assault.

It is something that victims have a lot of trouble talking about, for obvious reasons.

Doctors and midwives have a duty to meet all emotional needs, whatever they are. Bringing this to the attention of the senior midwife and asking to see their policies on this subject will give you some answers and hopefully, some resolution.

Your stories about HG are horrifying jemima a close family member had it and by her third pregnancy had spent half the pregnancy in hospital. She said one overnight stay the midwives counted her vomit 40 times. She was basically drifting in and out of consciousness and could barely remember it

I am expecting dc5

Dc4 was a five hour from first contraction birth, and back to back

Should i be worried that this one will fly out?

Do you find there's many first time mums with prenatal depression? I found that that there is lots of support for post natal depression but there's not much information for anyone suffering due to being pregnant

@FunInTheSun2019

Very young mothers

The youngest girl I've delivered was 13 and our unit has had two girls aged 12 in recent years.

@Innersmellbow

Too busy to deliver good quality care

There are times when the labour ward is very, very busy. On days when this happens, it seems that as soon as one woman arrives, another two phone, who need to come in. Then there's usually a very complex case going on in the background as well. It's just Sod's Law.

Naturally, on days like this, a third of the staff are off sick and at least two midwives are having Sleep Days, having been up for 24 hours on the trot and being exhausted as well as unsafe.

The senior doctors are away on a training day and the midwife in charge of the labour ward is in A & E because she was assaulted by an outraged relative.

Most of the patients are having serious and worrying obstetric problems.

The police will be there, too, as someone has found a newborn baby in a bin. They are also investigating the theft of some controlled drugs from the drug cupboard.

The drug cupboard keys are temporarily lost anyway as a careless midwife from the night shift has taken them home in her pocket accidentally and cannot be contacted.

Midwives from the ante and postnatal wards have to be pulled to come to the labour ward to help, so all their patients have sub-standard care as a result.

The husband of a woman giving birth has had a cardiac arrest while his wife was pushing.

A woman having triplets needs an immediate caesarean, which takes so many staff away from the labour ward and neonatal unit that both have to close to admissions.

The Flying Squad is called out to a woman who has given birth to a stillborn baby at 23 weeks. She is bleeding +++

I have been on labour ward when a good many things like this are happening - not all at once, but enough to stretch the staff beyond belief

I was the midwife who went to the Flying Squad call, by the way. Although it was a tragedy and a chaotic obstetric emergency, it was better than being in the labour ward on that particular day, I can assure you.

On another day, I was the midwife where the husband had a cardiac arrest. He did not survive. His wife gave birth to their sixth baby amongst the chaos.

I actually witnessed the man who stole the controlled drugs climbing down the wall outside the maternity unit, and called the police.

Sometimes it is very hard to give good care

Too busy to give good care Part 2

Of course, labour ward isn't always that busy.

I've been on night duty once when we had no patients at all. So we drank a lot of gin tea and had an impromptu game of cricket with a pair of forceps studied the most up to date research papers.

It is never acceptable to make a woman feel that she's taking too much of your time when you're busy. Women understand if you explain that you need to go to another woman for a short while.

I don't think it's impossible to treat people with respect when you're really busy.

But it can be hard. The NHS is seriously under-funded, as everyone knows, and staff recruitment and retention is a huge problem area.

Many midwives cannot afford to return to work once they have children as the cost of childcare is so high, again as everyone knows. It's also difficult to get childcare which fits round shift patterns. So a lot of practitioners are lost to the profession because of this.

And some just burn out.

@NotMyPuppy

Not remembering labour

Yes, a lot of women report not remembering much about what happened and it's a combination of pethidine and gas and air.

I had both with DD2 and I struggle to remember anything about it (fortunately, I think)

Cystocele

I would ask your obstetrician about this. I've got one, too, even though I never had a vaginal delivery.

Every subsequent pregnancy and labour puts a strain on that area.

Please talk to your surgeon as well as your obstetrician.

en.wikipedia.org/wiki/Cystocele

And I've got to Page 9, ladies

My best friend is a midwife and she does love it but hates the unsocial hours.

My question: Do you remember your first birth above all others or is there one that’s especially memorable for whatever reason?

Do you wish there was more flexibility with regard to part time working?

Jemima32 you’re a superstar. Not only do you sound like an amazing, caring midwife but you are taking time to give everyone such detailed answers.

Thank you for making me feel validated in viewing my “care” as poor. I did indeed write to complain to the hospital at the time. The response I had from the chief exec was laughable...”the midwife said she offered you a cup of tea straight after birth”. Like that was the main issue! Also made me marvel at the midwife’s fabulous tea offerings memory.

Thank you again to you and the colleagues of yours who do treat women in labour with respect and dignity.

IKnowYouAndYouCannotSing

What a wonderful User Name. I'm a choral singer and organist and I think this very frequently.

Anyway...……..

Most Memorable Labour

No, it wasn't the first. I do remember the first but there are loads that have stayed in my memory for various reasons.

Here's a sample:

• delivered famous actress and we spent her labour laughing at the "Top Tips" in Take a Break Magazine. (disclaimer - I don't read it regularly I have a subscription) Oh, and laughing through labour helps you to relax so your cervix dilates more rapidly.

• delivered a woman who arrived on labour ward saying she was in labour with her 14th baby. She was only in the delivery room for twelve minutes before the baby arrived and as soon as the placenta was delivered she reached into her overnight bag and handed me a VERY large and expensive box of chox, saying, "I brought this to give to the midwife who worked so hard to help me through my labour. These are for you. Thank you so much for everything."

• delivered a woman whose husband turned out to have escaped from prison to be with her during labour. He was arrested and taken into custody after the baby was weighed.

• delivered a woman at home whose baby was breech and her entire labour lasted 42 minutes. I was her independent midwife and I was staying in her house because of previous rapid labours, so I was there when the labour started.

• delivered a woman in hospital whose older DC attended the birth, aged 3 and 5. It was regarded as highly unusual in those days.

• delivered a sex worker who had intercourse in the labour ward bathroom half an hour after the baby was born. The lucky man wasn't the baby's father but he was her birth partner.

And my personal favourite

Sue comes into the admission room and says she's in labour with her fifth baby. She is correct. Cervix is 3cm dilated and thin. She is contracting every seven minutes.

Me: Right, Sue. I'll take you round to the delivery room.

Sue: I need to go shopping.

Me: Right. Maybe AFTER the baby's born?

Sue: We need the weekly food shop and I can't trust him (points to husband) to do it. You know what men are like. Always forget the toilet rolls and cornflakes. I can't risk it.

Me: Your last labour was 3 hours. I really think...……

Sue: I'm going to Sainsbury's. C'mon, Joe.

Me: (in disbelief) I'll have to write in you notes that I've advised you to stay, Sue.

Sue: That's okay, Jemima. I'll only be forty minutes tops. You've always told me that women should do what they like in labour.

(Sue leaves the labour ward, having a strong contraction as she and Joe walk down the stairs. Joe looks miserable but has not said a word.)

…..fast forward an hour and a half...…

Blue light ambulance pulls up and the paramedics deposit Sue hastily back right where she started, in the admission room. Joe is trailing behind with twelve carrier bags of shopping.

Sue: I WANT TO PUSH HELP ME JEMIMA GET MY KNICKERS OFF OH FUCKSAKE

I help her on to the examination table. No time to get her to an actual delivery room. I yank her knickers off with one hand and open a delivery pack with the other.

Me: Joe! Press that red bell on the wall! I need some help here!

Sue gives birth to a baby girl (this was before everyone knew what sex their baby was going to be)

Me: Joe! Please press the bell - I do need another midwife here!

Nothing happens. I look round. Joe is spark out on the floor.

Me: Shit.

I press the bell with my elbow.

Me: It's a girl, Sue. Well done! I'm afraid Joe's fainted, though.

Sue: Well don't bring him round yet, Jemima. We've already got four girls.

Me: (irrelevantly) Did you get all the shopping?

Sue: Most of it. Baby wipes were on two for three this week. Bit of aggro at the checkout though 'cause I was screaming with the pains. They made me have the ambulance. Reckon we would've got back here without it though.

@BinkyBunkyFintyCunty

Midwives and Tea

Ha!

The facts surrounding tea on labour wards:

• we drink it all day and all night, as anyone who watches "One Born Every Minute" will be able to see.

• we like to have many biscuits, cakes and chocolates as are available to drink with our tea. Patients frequently give us these and we always share.

• we call the post-birth cup of tea we give you the "fourth stage of labour."

when there's a pot of tea going (i.e. at any time of the day) we summon our colleagues who are with patients by saying "Mrs. Brown needs you urgently" to the unfortunate colleague who is WORKING while others are enjoying tea. In this way, the patient believes that her midwife has a valid reason for abandoning her. Although having a cup of tea is* a valid reason for abandoning a patient, IMHO.

• we drink gin tea even more at Christmas-time.

So, I actually believe the midwife who said that she distinctly remembers giving you a cup of tea when you complained about your care, since tea is a highly-rated beverage within the entire midwifery profession.

We even have a module on it. I received a gold medal for my dissertation on tea.

www.goldmedals/jemima/teadrinking in midwiferypractice

@innasnailshell

Yes, there would be more midwives returning to practice if there was more flexibility with regard to part-time working.

I was fortunate. I had a far-seeing manager who facilitated my returning to work at the weekend only. DH looked after the children and there was one more midwife available for weekend work. Happy days.

This was before any kind of part-time work was commonplace.

This same manager let me and a colleague who had children to job-share. We did nights for two years, working out our own rota. Again, the hospital got two midwives covering an unpopular shift.

I must get back to page 9

@LWMommy

No dignity in the hospital

What you describe sounds very poor and it would help if you went to see the midwifery manager and brought all this to her attention.

Nothing you've said really surprised me, I'm afraid. Some hospitals have a less than optimum environment.

Your post brought out, yet again, the fact that your needs were not met in an acceptable manner, as so many PPs have described.

When I had DD2, for various reasons, I couldn't go to my own hospital. I didn't tell them I was a midwife, either.

And the level of care was not what I would expect from HCPs. In fact, it was very much as you've described your own experience. The doctors were lovely but the midwives were shite not approachable or empathetic.

I did complain and they never wrote back!

Thanks for all these answers @Jemima232

What are the reasons you see why women have bleeding in early pregnancy? How common is it?

Hi Jemima

Thank you for answering. I did have a debrief but it was fairly rubbish as they had lost (or "lost") my notes. I wasn't allowed to record the meeting. The senior MW running it took handwritten notes and said she would write to me with certain answers about why those decisions had been made. After a few weeks, the letter had not arrived, so I rang up to see. They said that no one by the name of that MW worked there, and they had no record of me having a debrief.

Also I flagged my history to them at the 16w appt (it was a twin pg so had consultant appt at 16, 20, 24 etc). I asked the consultant to flag in my notes what I had told her so I did not have to explain about it when I came in to deliver. She wouldn't and just wrote "very long discussion re birth choices" in my notes and said she "did not feel able to support" any birth plan that did not involve labouring on back, epidural in situ, with CFM. We "discussed" this at every appt and she seemed to come around about 28w but she did not record this in my notes. Twin 1 suffered iugr in the last weeks, so I ended up having much more regular appts. None of the other docs would really listen and I had to have the argument from scratch each time. One told me I would have to lie on my back with my legs open in front of 8-10 people. I said I could not do this. She said "I am just telling you what's going to happen". Another told me, when I said I didn't want an epidural, "but we are passionate about women having epidurals!" and wouldn't discuss further. The docs when I was admitted for IoL were actually a different bunch and much nicer but they still wouldn't confirm that they would let me labour with just female MWs in the room, and other staff outside the door. I was in such a state by that time and saw a big group of male paeds and students walk past. I didn't know if they were destined for me (turned out later they were) so I lied to the MWs that I was not in labour - I don't experience strong pain- and they let me go the toilet where I delivered Twin 1 who was not breathing and his cord snapped.

Fuck that was long, sorry! will stop spamming your thread and thanks for answering x