What makes a good midwife?

[Freedomchick]

I am a mother and a midwife. I'd like to know what makes a good midwife so I can make improvements and always be a good one. I know I can trust you all to be honest. Much love and gratitude to you all. My children are now grown and are amazing, sensitive, accomplished souls & contributing wonderful things to the planet (if I say so myself). Their father wasn't around so I know without a doubt that it was the sisterhood of motherhood that got us through. So thank you.

DS2 was born blue. In my birth plan I had said that I wanted delayed cord clamping. The midwife tried to get him breathing by rubbing him with a towel but when that didn't work she asked if it was ok if she cut the cord and take him to the resucitation trolley. I wasn't going to say no but I'm glad she asked. She then stood at an awkward angle so we could still see ds2.

When I had my miscarriage the community midwife phoned me to see how I was twice afterwards.

A good midwife will know when to chat and when to shut up.

A good midwife will tell you how amazingly incredible you are when you are curled up in a ball saying you can't take the pain anymore at 1cm dilated.

A good midwife will be able to find something positive to say when she tells you there's been no progress for 5 hours.

A good midwife will also be able to make the best tea and toast in the whole world!

A good midwife will not withhold pain relief just because she sees herself as a guardian of natural birth.

A good midwife would read my notes for a few seconds prior to seeing me so I don't have to explain, EACH AND EVERY TIME, my entire history which is not an entirely happy one (one DC, then ectopic, lost both tubes, miscarried a twin in this pregnancy, since then other complications). Seriously. It's all there on the very first page. Why don't they ever read the notes? Their first question is always "So is this your first pregnancy?"

Sorry, bit of a rant, can you tell I had an antenatal appointment today ?

A good midwife is one who has time to be a 'with women' and can help you give birth to your baby safely. She's one who is alert to the fact that sometimes things go wrong but she is there to encourage things to go right. She is one who sees giving birth as more than whether you have pain relief or not!

My midwife is fabulous. She understands that I am anxious about this pregnancy (because of previous miscarriage). She listens properly to what I am asking her and explaining to her, and responds honestly - which the first midwife I saw didn't do at all and neither did my GP. Because I feel supported by her, she's given me the confidence to start actually enjoying the pregnancy instead of being terrifed it's going to go wrong any minute.

I cannot begin to explain how precious that is; for anyone who's suffered a loss, a good midwife makes all the difference the next time around.

erm..

treating my choices seriously. if i say as a first timer that i want to do it at home - that's how i want to do it.
If you think i should have an induction - that should be presented as a choice which you advise me of the pros and cons of.

encouraging - sincere encouragement - i really believed MW for DD1s birth when she was saying how impressed she was with how i was handling it, blah blahblah (even though she must see lots of women in labour) it helped. I trusted her implicitly.

actively seek to offer advice - simply ticking the box that says i want to BF does not help me BF. Knowing how many people don't ge on with it, it may be a good idea to provide information on the how in advance.

respect my house.

although non-interference is great - useful things like telling me not to push the baby out so fast i tear should always be said!

Listen. And hear what is being said.

I'm taking notes not just for myself but to spread the word. The word will be spread because I am passionate that women get proper 'with woman' care.

From the last few posts, quiet has come up as an attribute for a good midwife. To not be condescending with the way we address the pregnant/birthing woman. And yes I agree we don't need to call you mum. We know your name!

And as advocates why should we be hauling you around like 'goods'; you are a person and it's your body. RESPECT.

Thank God for the midwives that read your notes, get to know you and respect your birth plan. It's your birth. Why would we do anything else?

And naturally we are guardians of normal birth and yours and your baby's safety is paramount, so we must be knowledgeable and observant and listen. But those of us that promote natural birth MUST NEVER do it in opposition to the woman's feelings, wishes or desires; it's not our birth It's yours!

Thank you from my heart for your responses.

By sheer luck I had the same midwife with both of my homebirths. I had seen her all the way through my first pg which really helped to build up a good rapport. She is a tiny little thing but has an incredibly capable way about her. She never belittled me or patronised me.

In my second birth she told me her main job was to "protect my perenium" as I had a small tear with my first. I could have kissed her!

I requested to be transferred to her with my 3rd pg as I feel I know her quite well. She respects my decision to have homebirths, even with my first one.

She also makes comments afterwards like "Ooh are those normal tracksuit pants - not maternity ones - you look fabulous!"

And I must add that she has never had any children herself which makes her much more empathetic in my book!!

Someone who really listens, not just with her ears but with her BRAINS too!

I was in hospital for 10 days before giving birth a week ago. The midwives I had care for me before and during the birth of my daughter were fantastic. The listened to me, took my word for things - despite being an induction and my first labour it all happened very quickly. They gave clear directions when I needed to do things and were reassuring when needed.

The midwife care on the post natal ward was a different matter. I felt that I was asked to do things for no particular reason (like keep a feeding chart) and aspects of my care were looked over - for example my blood pressure was meant to be monitored every 4 hours. I don't feel that they were encouraging enough of my breastfeeding (a maternity support worker was actually the most encouraging), it is like the assumed that I would give up at some point.

My midwife held my hand, told me I could do it, & kept me sane during transition. I trusted her, she stayed with me throughout, she recognised when the baby turned briefly back-to-back, got me to try different positions & basically got me through it.

And then she ran me a bath, made my bed (I was at home) & cleaned up! I named my now 6 day old DD after her own DD.

I'd never met her before, btw, but she was v v experienced (as was her colleague who arrived for the delivery), & clearly knew how to build instant rapport. That combination of real empathy & practical, hands on experience is what made her so good at her job.

For me, I like midwives who make small talk and ask me lots of questions, both ones that are relevant to treatment and small talk ones. I want them to be as reassuring and as comforting as possible when I am in pain and distressed. I want them to be decisive, as long as they're not making decisions without my consent, or that I disagree with etc.

It's so hard to pin down what makes the good ones good. It's such a tough balancing act between being mentally sharp and knowledgeable while also being really socialable and friendly, and the two don't always go together.

From reading MN, it looks like by far the most common complaint is midwives who don't take pain relief requests seriously, so I would say you should offer lots of pain relief.

Oh, and be aware that DH exists and be nice to him because some of them they have feelings too

As well as a lot of the things already mentioned, a seemingly small things really stood out for me during the birth of DD2.
When I was just ready to push I said I was scared and her instant reaction was 'and that is totally normal'. That settled me and gave me confidence in myself.

A good midwife is someone who is caring, knowledgeable, understanding, sympathetic and respecting...

I had two midwives while I gave birth due to a shift change. The first one was lovely. She explained everything to me. I had felt to see what was going on and I said I thought I was about five centimeters and she BELIEVED ME. Unlike the woman on the phone while I still at home who made out like you needed to be a qualified professional to work out that something that felt very like a bag of waters was in fact a bag of waters. I was actually completely right and I only just made it to the hospital before my waters broke. The midwife I had after the shift change was more than competent and friendly, but she very much had her own way of doing things and didn't listen to what I wanted. I was dreading having to beg for pain relief. I knew I definitely wanted it and she got in a huff when I insisted. She also got very offended that I refused to have a suppository which was just plain weird. You must remember though- it's less important for a woman to have a suppository than it is for her to think back on that moment and feel totally violated forever afterwards. Other than that she was a gem. She had to be a bit firm with me during the pushing but she did it right- she told me what I had to do but wasn't rude, she helped me move without being rough and she told me when I was doing it right.

I had a straightforward labour with gas and air and a water birth. About half way through the shift changed and Debbie took over. Our eyes met over the taps and I trusted her instantly. Dunno why, but she had authority, she was calm, she was funny, she was nice to dp. A good mixture of been there before but also acknowledgning the momentousness of what was happening to dp and me.

As I say it was all fairly straightforward so didn't really get to stretch the boundaries of the relationship! Maybe that's it - we had a relationship in that short time. I haven't seen her since I left hospital, but I gratefully think of her often.

I had a fab MW in the community, she was so friendly and explained everything really well. I think demonstrating confidence in her professional ability was important, while also showing respect for my views.

During my birth I was blessed (again) with amazing MWs, as I had a HB I had 2 MWs through the majority and a student MW. Between them all I got a mixture of approaches and this helped me. What I mean by that is the student MW was really sweet and encouraging, while the other more experienced MW was a bit more assertive with me. That sounds bad but it was not. She was kind of 'come one get on with it, of COURSE you can do it, stop being silly'. This worked for me at the point where I was saying that I could NOT go on.

The only thing that did annoy me is.....

"It's called labour for a reason".

Oh really, I had not made that connection, I thought it meant something different!

Sorry, but please do not say this to a woman who is having constant contractions and the G&A is not working properly.

Just wrote a huge post, then deleted it as too much waffling

But basically it came down to 2 important things for me being to listen to the woman, and not to automatically dismiss what she is saying because of thinking they "know better".

In particular, not to dismiss what the woman says about how much pain she is in/how far along she thinks she is, based purely on a phone conversation or a single examination and on some textbook idea of how labour goes.

Both I and one of my friends had problems with mws (not sure if it was the same one both times!) not wanting to "let" us come in to hospital when we phoned, as they insisted it was still too early, we didn't need to be in etc... - in her case, by the time she insisted on going in anyway she was 8cm dilated, in my case 6cm, I had been having contractions for nearly 24 hours already, and we found later that baby was stuck in an odd position so I wasn't dilating properly. If I had waited for contractions to be as frequent as she said, I would NEVER have gone in, and would have had to continue coping with a lot of pain on my own (and DS would have stayed stuck!). So it would have been better if she could have taken my word for how I was feeling, how much stronger the contractions were getting etc and let me come in earlier.

The other time, I was nearly sent home as at assessment they said I was only 2cms dilated - even though I said cxs were getting really strong and really frequent. Luckily (and only because I was hoping for VBAC) they eventually arranged for me to stay on in an antenatal ward instead - and within an hour I was nearly fully dilated and getting urges to push! So it would have been good for someone to have taken it seriously when I said things seemed to be moving really fast, and not almost sent me home.

Saying that all the other mws we dealt with were very good, and some were absolute stars!

I am looking into becoming a midwife but need to get the right alevel then do the degree, but it's great reading all the advice on this thread...it's such a fine balance but I agree that a good midwife makes the whole birthing experience a memorable thing rather then something you'd rather forget! Had a very standoffish MW for my first homebirth but was rescued by an absolute angel, Gaynor, as i was trying to push after 34 hours! then had a great team on my second HB, who only just made it, much to my husband's relief.

I am also mother and Midwife. I reckon as a midwife you need to be all the things already mentioned, but also a really good actress! After 12 hours of hard work, when all you want to do is go home and never see another pregnant woman again, you need to be able to put a smile on your face and come across as enthusiastic and caring even if you're not feeling it at the time. Plus you also need to act calm and confident when you're bricking it, so that women don't realise you're a bit nervous

A midwife I think needs above all to be compassionate and be able to support and be interested in the woman and care about the job she does. My labour was frightening-nothing wrong through most of it but I coped very badly with the pain. I didn't want an epidural really but my 1st midwife was quick to suggest one and didn't have time I think to help me in any other way. It took 7 hrs for it to come and i was 8cm by the time it got to me- wish that I had been more supported to try and carry on as I then had to wait 2 hours to push. The 1st midwife finished and second midwife came who barely spoke to me and I gas to remind her when it was time to push. I was exhausted and pushed forcan hour and a half during which time she left me to push with my hubbu having to check progress down below. She just wrote notes on the side coming over every now and again to say "your pushing wrong" and "you better push harder if you go longer than an hour they'll probably use forceps". When I finally got my baby out she was pale and floppy with the cord around her neck and needed oxygen resuscitation. She forgot to tell the doctor who she eventually called until after baby was better about the cord and then got told off because she failed to get cord blood sample. To top it off I had 3rd degree tears.

Sorry for long post but am hoping it will help make a difference!

Thank you for asking. In the wake of recent threads especially.

I think ohmeohmy really hit the nail on the head when she said to remember that eventhough it is just another day at work for you, this baby will only be born once.

Ultimately ai believe it comes down to respect (real respect of the individual woman and of the birthing process), compassion and humility. If you have those things in place the rest will come automatically.

You will listen to the woman, and be able too read her. You will hold her hand if that is what she wants or leave her alone. Above all you will not dismiss her experience because you have witnessed so many but help her live through it.

I think a good midwife is aware that it's a life-changing event that you will remember for your whole life. I had a lot of midwives through my delivery and there was only one I really, almost irrationally took against. I asked her why she was studying midwifery, just making conversation, and she said, 'Oh to increase my job prospects for when I move home, not that there are any jobs anyway.' Her whole being screamed boredom and lack of enthusiasm and I did think, why are you bothering? It doesn't seem to me the kind of job you would be able to do unless you really, really loved it, because it is so emotionally and physically demanding.