I'm a Midwife AMA

[MidwifeAMA]

Experienced midwife, hoping to spread good quality info :)
AMA

@MidwifeAMA "This is a different pregnancy and a different baby and so there's a really good chance all will be well" said compassionately actually could be reassuring for a lot of people.
Yes I would have been happy with that. A bit of compassion would have gone a long way. Tone of voice and body language are so important aren't they. I imagine it's difficult to feel you have time to be kind on top of everything when you're so busy, but it does make such a huge difference.

@MidwifeAMA when a woman has a history of precipitous labours, should this be taken into account when administering pitocin for induction? I feel I was over stimulated by pitocin with my second and nobody took into account my history.

My baby (born last year) had GBS sepsis and spent 2 weeks on NICU before being well enough to come home. My waters broke approx 15hrs prior to contractions starting at 37.5w, DD was a tiny 5lbs 12oz, poor feeding at birth and her legs were purple - all big risk factors but the infection wasn't diagnosed until she 23hrs old and nearly too late.

The GBSS charity is supporting a clinical trial which is aiming to assess whether routine screening would reduce the number of babies that develop GBS induced sepsis or meningitis in the UK. I get that GBS is transient but I've been surprised at the number of HCPs which have utterly dismissed whether screening would make a difference (in my case, i couldnt book the private test due to covid isolating and then DD came at 37 and a half weeks straight after my isolation finished). In fact, my midwife never even mentioned GBS to me - it was only after i asked her about it due to another family member having a baby that developed GBS meningitis.

What is the position in your trust and what do you think could be done better to prevent cases like ours? Do women need to be better informed about the dangers of GBS to be able to make informed decisions about their care?

What is the position in your trust and what do you think could be done better to prevent cases like ours? Do women need to be better informed about the dangers of GBS to be able to make informed decisions about their care?

not the o/p but 19 years ago my trust were running clinical trials on GBS outcomes and routinely screening. They swabbed me at birth, picked up the infection and dd was monitored accordingly. They also had very strict monitoring and prevention of MRSA protocols.

i think the issue with screening is it has to be done shortly before or around the time of delivery. Otherwise you may be giving ab’s to women who have been +ve but are -ve at birth, with the associated risks of antibiotic resistance. Last thing anyone needs is ab resistant GBS!

How much blood loss in childbirth would be considered dangerous / at what point is a transfusion considered?

I had a student midwife at my booking in appointment. After being told it was my second pregnancy she said “and was that a baby or a miscarriage”? Fortunately I have never had a miscarriage but I imagine that would be very upsetting for anyone who had lost a baby.

I'm due on Christmas Day! Should I be worried about staffing?!?

There's a raised chance compared to the general population but in my experience is still quite uncommon. Much more likely that it won't happen.

Absolutely, they will put everything in place to help keep you safe :)

Maternity isn't really affected by weather, we run 24/7. My advice would be to get some of that cool face spray, and a mini handheld fan, freeze some bottles of water to take in with you so they stay cool for longer, and try not to worry. Women have babies in hot countries every day.

This is awful. I think you get bad eggs on every job but I think it's a sign of the culture in the unit if this isn't pulled up and stamped out

Thank you! All I’ve read up until now is how hot maternity wards are in normal circumstances!
Being induced on Monday now so it’s happening then whether I like it or not - ice water at the ready!

Thanks

This sounds like a unit with a culture problem.
For so many midwives to be presenting in that way is more than a bad egg.
We absolutely don't have a 'normal births at all cost' agenda in our unit. We are the experts in natural physiological birth processes, that's our role, but as part of the big picture of safety, maternal choice, experience.
We are very realistic in our antenatal education with the variety of birth outcomes you may experience, glossing over the complex births helps no one and potentially breeds fear.
I'm sorry you had this experience, it sounds dire.

Do you feel stmw's training has been affected by covid? Are the students you are working with of a good standard?

I will add re the staffing question, for every 30 new midwives that qualify, 29 leave or never start.

Midwifery is tough at the moment, that's for sure.

Absolutely not in our hospital, we are shattered but we are shattered because we want families to have the best care.
This makes sad reading, because kindness and compassionate are really important in our unit, I just can't imagine midwives talking to women like that here.

We have BFI accreditation so feeding support is really good quality.
Thinking myself very lucky to work here

Ivf thyroid gbs

So in our area we would monitor your thyroid function with blood tests every three months.
If well controlled no need for anything else.
Ivf pregnancies, once pregnant, are now treated as a normal pregnancy.
GBS is relevant for labour but doesn't change care plans in pregnancy,
None of those would indicate a need for additional growth scans here. It would be an initial planning appointment at the beginning of pregnancy to discuss additional blood tests etc then you'd revert back to midwife led care.
If you have any doubts though ask your midwife, she can discuss local guidelines with you.

But kindness is the one thing we can offer that is freely available, and so should be non negotiable.
I'm sorry you had a negative experience.

Pitocin- are you in the USA? USA very enthusiastic with their interventions, and appalling health outcomes for mums and babies.
In the uk we start the oxytocin (pitocin) at a tiny dose and increase it slowly until we have the right frequency of contractions, and we reduced back down if there's too many. It is sometimes unpredictable how someone will react but as long as they increase gradually and are responsive to the effect it is usually ok.

With planned csections, I've heard about mums being able to ask for adjustments to make the experience more of a pleasant and bonding experience. I'm sorry I can't remember what the term is, but things like having their choice of music played, or aromatherapy and then to things like delaying cord cutting, exposing the child to vaginal fluids which benefit baby.

How common are these types of csections and do the obstetrics teams respond positively to these requests?

It's a tricky one, it's pretty unreliable to test for but I'd welcome a trial to see if the number of women who would need antibiotics would justify the outcomes. If we are giving decent antenatal and postnatal care we should pick up many of those babies before infection takes hold. Spotting little babies in pregnancy, monitoring them closely afterwards to ensure they are feeding well etc- poor feeding is a red flag to observe for infection here.

Above 500mls is considered a post partum haemorrhage but realistically most women tolerate 1000mls comfortably. It's quite dependant on your size, if you weight 50kg then 500mls will be a bigger proportion of your total volume and may make you feel unwell, but if you're 102kg you'll probably barely notice it. Also what your iron levels are like, if you start off low then you'll drop to a problem level
Much easier.

We are all here 24/7 365days a year!

They are definitely less experienced and less confident as they missed chunks of their training. We are trying to support them more and make sure their post qualification assessments are robust