Student midwife due to qualify this year. AMA.

[Anonymous2003]

Thought this may be fun :)
Please no questions seeking medical advice

@Earwiggoearwiggoearwiggo we had a full mental health module this year as well as guest speakers from perinatal mental health teams

Have you ever felt unsympathetic to a woman that is hysterical or screaming a lot? How do you manage such cases?

What were your feelings when you saw your first birth?
I still remember the look of awe on the student that witnessed my child's exit!
Do you keep a personal note of all the births you've witnessed?

@mdinbc hmm I wouldn't say unsympathetic... I would say it can be frustrating when a woman is in 2nd stage and screams during contractions and wont push!
I try to be firm but fair (still practicing my stern voice) and coach the woman through using entonox during contractions or through pushing if she is at that stage. Eye contact and physical touch in between pains can help build a connection and reassure her that I am trying to help her.

@Clingfilm the first birth I saw was a section, I felt very emotional and couldn't stop smiling! It was amazing.
The following day I witnessed my first vaginal birth which was also amazing and I will never forget.
I have a board with pink/blue feet for all the babies I have delivered (we have to deliver 40) and I write on them the date, time and weight.

Please encourage everyone to ask the domestic abuse question more seriously at checking apt and to keep asking and to give examples of specific behaviors rather than just ask if abuse is happening

I can see why you haven't seen a home birth but it seems a shame. It's such a different experience to a hospital birth. Another question, a more general one this time. Is the importance of how language is used and the effect it can have on a labouring woman, discussed on your course?

I am rewatching the first series of Call the Midwife. Do you ever wish you could back in time and work in that environment?

Is it normal to be discouraged to use gas and air during the pushing stage?

Also what are your thoughts on Group B strep testing? Do you think everyone should be offered it or at least made aware of the risks? I'm astounded at how so few people seem to be aware of it.

@Philandbill could you be more specific as I'm not sure what exactly you are asking about 😊

@JoyousGreyOrca I think the old school uniforms are lovely! But overall no, medical advancements are amazing. Plus women who were unmarried etc were treated with prejudice compared to today

@Yuckyyuckyuckity yes we would encourage women to use their energy for pushing rather than breathing through contractions with gas&air.
Women are not routinely tested for GBS during pregnancy but if it arises she will be made aware of the risks and receive antibiotics in labour.

What role do midwives have to change that in your opinion? Given the studies suggesting c sections were safer were debunked decades ago? Vaginal births have significantly better outcomes for women (and you’ve admitted you would prefer that too) yet they’re being forced into unwanted sections due to lack of support.

Is there a reason you can think of that a woman would be denied gas and air? And is there any consideration of previous birth history when a woman arrives even if they aren't much dilated?

With my DD I attended the hospital having three contractions in ten minutes. My waters had gone and I was struggling with the pain. I was assessed at 1-2cm and told I could either go home or go to the ward to be induced. I declined both as I was pretty sure I was in labour even if my cervix didn't agree!

They found a room for me to "see what happens" and I asked for gas and air but they said no (I didn't ask the reason). Two hours later my husband went looking for a midwife as I was pushing. I was 10cm and as they were rushing round trying to get a monitor on the baby & me (we had been completely unattended), I asked for gas and air and was denied again, she told me I needed to concentrate for pushing.

I'm pregnant again and hoping that next time they'll take me a bit more seriously about my pain levels and not just assume my labour isn't progressing if I am only 1-2cm again, because it advanced so quickly last time. I'd rather not have a completely unmediated birth this time!

@SP2024 I'll be honest. Midwives generally have lost their skills in facilitating breech births and would not want them to become the norm again.
I'm just saying what I'm seeing in practice.

@heroinechic I know some hospitals have done away with the gas and air due to midwives exposure to the chemicals.
I don't think I can comment on your particular situation but it sounds a bit of a strange one and I'm sorry you were left alone with no support.

Sorry to jump in here. Answering this as a midwife, hoping to shed a bit of light.

Midwives can give Entonox as a midwives exemption but only when the woman is in established labour (at least 4cm). Personally, if you were contracting 3:10, I would have advised you to stay in and offered pain relief, but obviously cannot comment on your individual case as I wasn't there. As the OP said, we often encourage women to ease off the entonox during the pushing stage as it can make pushing less effective. That being said, if the woman is pushing well and baby is coping, there's no reason to take it away.

Regarding breech births, they have become less and less common in this country and as a result, lots of midwives and obstetricians have lost confidence in facilitating vaginal breech deliveries. That being said, I always discuss the option with women if their babies are breech, as some women don't realise that a vaginal delivery is even an option if baby is breech. As a student, I attended 3 breech deliveries (2 sets of twins, 1 cephalic and 1 breech - both breeches delivered but an obstetrician in theatre, and 1 in a regular delivery room). At the trust I work at, we're very lucky to have several internationally trained midwives who are extremely competent and experienced in managing breech births so maybe that's why I have witnessed it.

@Mama05070704 in my trust the only breech birth recently has been a twin delivery, one cephalic one breech like you said. Its great that you have staff with experience in managing breech!

@Anonymous2003 phrases like "just pop on the bed mum", "mum, I'm just going to..." etc rather than using a woman's name and explicitly asking for permission. And, to be really picky, women give birth, pizzas are "delivered". Language is really important and empowers or disempowers women. Have you been pointed towards the (short) book "Why Human Rights in Childbirth Matter" by Rebecca Schiller? It's a short read but a very thought provoking one. I'd be interested to know what you think of it.

we don't want to give an epidural too early in labour or too close to delivery.

You said this right at the beginning @Anonymous2003 can you explain why?

Also if you don’t “do” breech births, what happens if the baby is breech now? I had twins where twin 2 was breech, and am curious about present practice.

Do you think more primigravida women would elect to have a caesarean section if they were properly counselled on the 6% risk of a third- or fourth-degree tear (an obstetric anal sphincter injury)?

@Philandbill oh goodness I personally would never call a woman mum 🤣 I always use her name and speak to her like an adult! However you gauge people and some women really like you to be very gentle etc with them. I haven't heard of that book but thank you for the recommendation I must check it out!

Have you been given an idea as to what you could do once you're qualified? As in, what other areas of midwifery you can go in to rather than just on the labour ward?

Do you have a plan to go in to any other specialties?

@timetobegin too early and it can really slow down or even stall labour. Too late and the woman may be in way too much pain to be able to even sit for the epidural. I have had a few times when the anaesthetist has become setting up for the epidural when it turns out the woman is desperate for it because she is in transition!
Generally if a pregnant woman has a breech baby she is booked in for a csection ... Doctors are supposed to discuss vaginal birth as an option but from my experience they tend to really skim over it :/

@BumpandBounce I'm not sure, I suppose everyone is different and some may perceive that risk as scarier than others would.