I'm a Midwife AMA

[MidwifeAMA]

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

What thank you gifts do midwives like best? I've had a really lovely community midwife, consultant and mental health midwife so wanted to get them a little something they'd actually want/use!

No idea, just seems to be the pattern. Everyone is different though so it's certainly not a given.

Induction rates are through the roof. I think the obstetricians are getting very risk adverse, and some don't always paint a balanced picture in terms of absolute and relative risk, alternative options etc. once a woman has been told her baby could die it's very hard to then try to redress the balance.
It's also become so that it's now disapproved upon to measure a units outcomes by mode of delivery- ie you can't weigh up a unit by how many CS they do- which is to prevent the restriction of CS to "keep the numbers good" when actually it's the safest option. The flip side is that we also do need to look at whether we are over intervening, as I suspect with inductions because too much too soon is as much of a problem as too little too late.
We need to audit whether this huge increase in inductions is actually improving outcomes or not.

Do you have a local birth reflections service who could look through your notes with you and try to gain some clarity?
It's really unlikely to happen again, particularly if there was no clear reason for the infection. It's often just bad luck.

All babies are precious, but some parents are more anxious than others because of their journey- ivf, losses, medical history and so reassuring them that their baby is precious and we are focused on helping them stay healthy and safe is always a good thing.

Gender disappointment, welI think it's okay to be sad about the baby you didn't have whilst being happy about the one you did have. We all have an idea of what our lives might look like and lots if people have a preference. It's worth being careful with how you express it though, I do wonder about the babies who's mother splash their crushing disappointment all over take a break magazine.

DD2 was born with a chest infection and had to go on antibiotics at birth. I've always wondered how that can happen. I thought babies were totally safe in the womb. Labour was 4 hours. Vaginal. No complications.

Do you typically notice new mothers (parents?) looking more tired as the time goes on?
I just gave birth and at first, I think I had so much adrenaline, I made an effort with making sure I was dressed and had some makeup etc. and now when the midwives come, I’m not even out of pyjamas, with barely brushed hair 😅

Are there any particular reasons to get a retained placenta, requiring manual removal in theatre? Thanks

You sound delightful

This is absolutely not ok, please go and see your GP for a gynae referral. There is lots that can be done, please don't accept it as normal.

AgathaMystery: "Sorry but are you sure you’re a midwife? It’s been all over the news. How have you managed to be naive to this?"

I'm not naive to the wider issue, just to this particular news story. Possibly because Im not watching much news, I'm busy working 50 hour weeks to prop up a broken service, and to ensure when I go home I can hand on heart say I've given my women the absolute best possible information, choice, respect and kindness that I possibly can. Perhaps you should give your kindness skills a refresh, because you're sounding like part of the problem more than part if the solution.

Community midwives usually have around 80-100 women on their caseload if they work full time. Depends on the business of your area also the way you provide care. Continuity midwives who provide care for birth too work with much smaller caseloads as birth is a time consuming affair.
In the labour ward/delivery suite we aim to give 1:1 care in established labour but the reality often means you'd have a labouring women, plus one or two others postnatal or in with another non-labour issue. Busy units probably worse, quiet units probably less.
Home births it's two midwives to one woman, some really excellent tlc happening at our home births.

Thank you so much for starting this thread, it's so interesting! And thank you for the work you do.

I'm 16 weeks into my 3rd pregnancy and will have a c section (1st was footling breach, 2nd labour didn't progress). For my 2nd c section i was told I had a flabby uterus when I was being sewn up: I didn't notice much at the time but i remember now a moment in theatre where things got a bit urgent and rushed as people moved around me to administer meds and sort something out in my abdomen. From reading now I understand this is uterine atony and is one of the most common causes of PPH - I mentioned it to my midwife at my booking in call, but she didn't seem concerned (though it was just a phone appt), and I won't see my consultant until October. Should I be worried and push for a plan to be outlined? I am a worrier and would rather know how this situation will be handled!!

Also I'm due on 30th dec - 39 weeks puts my delivery at 23rd dec. What are the chances of them a)agreeing to bring me forward a couple of days so I can get home for Xmas, or b) making me wait til after Xmas and delivering me on or around 27th? Are electives scheduled on these days?

I'm sorry you have such a traumatic experience. The birth trauma association are really helpful, you might find some good resources with them for working through previous birth trauma or your local hospital may have a birth reflections service.
When you are having your second baby you tend to find it's quite a different experience, generally labour is more straightforward and you don't get that early labour advice that feels a bit of a fob off.
I think it's really hard to guess the culture of your unit but generally the majority of midwives are in the role because they want to give good care. if you meet your community midwife and you don't gel you can ask for someone else.
If it was me, and my goal was to feel in control but avoid postnatal stay I would do a Hypnobirthing course, really practice getting in the zone and blocking out everything around you, then enjoy the speed benefit of second births, and go straight home if your in hospital or look at home birth/midwifery unit is suitable.
Home birth offers you a total change in the dynamics, the midwives are guests in your home, you have their total attention.

Thanks there are lots of us who really, deeply care about women and their motherhood journey. It's so important to so much of what happens next.

Glad you had a positive experience, birth often throws the unexpected at us, but it's never boring!
Generally people tear much less/not at all with second and subsequent births.
Look at perineal massage in pregnancy, warm compresses for second stage, good positions (not on your back), waterbirth and focus on gentle birth techniques like J breathing to blow the baby out rather than shove, all of which will reduce the chance of significant trauma.

Yep, two babies, both after being a midwife for a while. I don't think you need to have children to be a good midwife but think you empathise better when you know exactly how bloody sore rib flare can be or have been on the receiving end of some of the procedures. I had two really opposite births, one complex on the labour ward, one quick on the midwife unit.
There's a womanly connection when someone looks you in the eyes and tells you how intense it is, and you can honestly say "I know, I really know".

Absolutely, we have a blessing and a curse of being memorable, it's quite a lot of pressure!

My experience of labour was that it was the most excruciating and frightening thing I've ever been through. How do you cope with seeing women in such desperate pain and feeling so desperate? Even if I just know one of my friends is in labour, I get really weepy until its over. How do you cope with seeing women in that level of pain?

You need a really good debrief of your previous birth, so you have a birth reflections type service locally?
The risk of bleeding can be increased by lots of things- extra long labour, hormone drip, extra big baby, excess fluid, or at total random.
If you've had a heavy bleed before we offer different safety measures afterwards to reduce the chance, and more likely than not it won't be a problem, but do speak to someone about what happened last time.

The injections are based on a risk assessment of chance of clots.
You score for things like bmi, age, emergency C-SECTION, family history, etc- so it may be that you don't score high enough to be recommended them next time, or actually you might look at the chance of a clot and think "actually I'm happy with that small risk and I choose not to have them". Remember everything is your choice.

Most midwives have high standards and would pull their colleagues up on poor care and bad attitudes.
Also women are powerful, when they complain they are listened to and action taken. I've managed complaints myself and poor attitude would be taken very seriously.

The measurements are individualised so there's no standard ideal size, what's normal for a 6ft2 woman wouldn't be normal for 5ft woman.
If the docs have reviewed your scan and are happy with the pattern of growth that's reassuring. They are all individual and some one has to be top end of normal, if growth was excessive they would offer the diabetes screening. It sounds like you have a baby who is healthy and meeting its growth potential.

Please talk to your midwife so an individualised plan can be put in place, there is additional support available.
All things are optional. Always.
It might be that you decide to decline vaginal examinations completely, and that's totally your choice to do so.
Everything that is offered should come with a rational- and so you can then decide if you think it's a worthwhile task.