What do you want to say to midwives?

[Whistleforit]

Have been asked to speak to a conference of them about What Matters to Women from patient perspective. Come on, what you got for me? :)

Whistleforit you asked about POV's being imposed and how this could be addressed.

Not sure I am best placed to say tbh - I don't work in clin neg not the NHS.

However, when I go to a hotel, I get asked for feedback and you can bet management look at those comments and act on them.

I know for certain from my work that this feedback loop just does not work in the NHS; there is a great deal of 'managing' of information to present the best image. There doesn't seem to be a great willingness to ask questions that might give rise to uncomfortable answers.

May be the Francis Enquiry will have some effect but that could be overly optimistic!

I think the real shakers and movers will be the media and social media like Mumsnet

No pressure then!

correction: I work in clin neg not the NHS.

My stepdaughter is a couple of weeks into her training.

I am sending her this thread.

I am a nurse (RMN) and agree with the poor levels of nursing care demonstrated by many MW's. To bleat "we're not nurses' during training when they are being shown how to carry out post surgical care/make beds/do wound care/obs....Whatever...This is what I witness from many student MW's who do not seem to grasp that many of their clients will have medical issues, WILL need nursing care. I mentor student MW's because they do a mental health placement and do my best to ensure I address post natal depression/Puerperal psychosis but also try to emphasise the massive psychological and hormonal upheaval even the happiest and most contented of new Mothers experience.

The psychological side of care can go out of the window as do basic respect and retention of the NMC codes of conduct- non judgement, consent (not assumed or implied but EXPLICIT), unconditional positive regard. I wasn't bothered about 'getting to know' my MW's or having anything other than a functional relationship with them but many women are.

If I'm going to be patronised by a HCP during pregnancy and birth then I'll take an OB over a MW any day.

I have a brain and feelings, I am not a piece of dead meat

Ok, two kids. What I want more than anything is:

1. Do not patronise me, call me 'mum' or talk to me like I am three (sorry to disagree with the toddler bit). It makes me not trust you as a professional and, when in a lot of pain, it possibly makes me want to lamp you. If you get this bit right, I will forgive pretty much anything bar negligence.

1. Please believe me when I say I am in a lot of pain. When in my first labour, I had a long and very painful latent phase. I was patronised and dismissed and my pain treated as 'just a hysterical first timer'. I can tell you from the subsequent labours (the second of which I had no pain relief whatsoever bar the pool) that I wasn't. It did hurt a lot at that stage. Just as much as it would later.

1. Do not, under any circumstances, tell me off for not making enough effort. I haven't slept for 72 hours, I may actually lose it.

1. Please do not get so focused on timing my contractions that you lose the reality of what is happening in my labour. I couldn't give a stuff if I'm not in established labour because I'm not 3 in 10. This baby is coming!

1. You are meant to be looking after me. That means, however rude and wafty and dismissive consultants on rounds and the anaesthetist are, you are the one I want to bring things back to me and talk to me like a person. Don't have conversations in jargon over my head, or worse behind my back as I sit shaking with fear as you say incomprehensible things about placing the epidural.

Never ever refer to a woman having a low pain threshold or compare to others. This happened on my two births & I can precisely remember the wording used. In one case I had syntocinon with no painkiller to deliver a back-to-back baby after 48hrs stop-start labour so yeah, it was painful. The other, a manual check for placenta remains so a whole arm up there - again quite painful unsurprisingly.

Do not talk to the birth partner even if it appears the labouring mother is "out of it". By all means, explain to them afterwards as well. Likewise, as has already been mentioned, do not make comments to other staff or when you think you're out of earshot.

Basically, retain normal levels of courteous, respectful, caring behaviour.

Oooh yes, that's my bugbear too. "Some women just have different pain thresholds" . I was told I had a low pain threshold. You know what, next time round I delivered a back to back baby with nothing (circumstances rather than choice) and internals are still the most painful thing I've ever experienced. The worst bit of both pregnancies pain-wise was a failed sweep. I don't have a low pain threshold, and even if I did, how is that helpful?

No excuse for the loaded pain comments because in training you are taught 'Pain is whatever the patient says it is'.

Please remind HCP's of this if you feel able to.

Don't assume because we are not screaming our heads off that we are not feeling a lot of pain. Some of us are simply not screamers.

I'm happy to say all the midwives I dealt with (probably at least 60) with two babies were fine, mostly very professional, helpful and supportive, which is pretty good seeing as almost all of them had to get to grips with my complex notes having never met me before and figure out what they were meant to be doing. At least my notes had a list of scheduled appts and various other info pages included so I knew what was when.

I would say, apart from asking what level of knowledge someone has and then checking they've understood what you've told them, please don't make promises you can't keep, and if there is a problem with the service to you as a patient, apologise for it. My postnatal care the first time was shit. My complaint letter was fobbed off (admittedly the new head of midwives hadn't been in post at the time so little she could say). Second pregnancy triggered nightmares. Cue psych involvment to deal with PTSD.

It was hugely alleviated by a lovely MW I saw who got me to tell her about my neglect previously and said simply "That should not have happened. That neglect is totally wrong and should not have happened to you. I am very sorry. I know there were big problems back then and while I don't want to say we have no postnatal problems now, it is much much better - for starters instead of 80% bank staff on nights, we now only have around 10% who are mostly regulars. I hope you will find the service is much much better. I will put on your notes that you were badly let down last time and they had better be good this time."

And they were. Faultless care. Thing is it was probably a lack of care assistants rather than midwives who were the problem, but if you are given a named midwife at the time and have no clue who else is on the ward, its the MW who gets the blame. Equally I have no idea if MWs are responsible for someone strolling in at 6am announcing they are going to demo how to top and tail your baby (ds and I and my terp had finally got to sleep around 5am. Terp had no idea what the woman wanted. I just knew that ds and I needed sleep so got terp to relay 'fuck off'...) - but if MWs have any influence over schedules of the postnatal ward, actually not waking up sleeping mothers would be great!

Actually worst MW I had was when pushing with dd - she was perfectly OK, but tiny and had a dislocated shoulder, so totally useless at helping me into a good position. Don't MWs get sick pay?

Actually, probably summarises to "Dear MWs, please lobby your superiors as much as necessary to ensure you can do your jobs and other jobs involving pregnant/labouring/postnatal women also get done. THanks."

I was pretty lucky with my MWs in both pregnancies (in different countries).

But I would agree that LISTENING to your patient is the biggest thing you ca do for them - LISTEN AND HEAR. Not stand there pretending to listen while not paying attention or wondering when your teabreak is due or whatever. And certainly not thinking "Oh here we go, another paranoid/feeble/hopeless case".

Numerous of my friends have had bad experiences: from being patted on the cheek and told "you don't have the face of a woman in labour, go home and have a bath" (HOW fucking patronising?) - friend then couldn't get out of the bath and needed and ambulance; to being told to go away and come back when the contractions were less than 2 minutes apart without checking her dilation - her DH said, they're already 1.5mins apart would you please check her? she was already 10cm dilated and barely made it into the birthing pool in time! And plenty of other shitty experiences in between, most of which seem to come from the MWs belief that they always know better than the woman in labour.

Of course they will have seen more labours than any mother, especially a new one, but that doesn't mean that the mothers are thick/unknowing - give them some credit!

When a MW becomes totally jaded with her/his job, she/he should change it. Giving birth is still an amazing thing, and especially for the woman doing it - don't trash her experience with your boredom with the tediousness of it all.

And as a more specific point - I was told by the MW who cleaned me up after DS1 that giving birth on your side (left in particular? not sure about that) was the best way to avoid tearing, which I did - if this is true, and MWs know this, then WHY THE FUCK DON'T THEY TELL MORE PEOPLE??

Oh oh oh - and PLEASE make checking for tongue tie, manually as well as visually, a mandatory post-delivery check.
If the drive is still on to get more women breastfeeding for longer, then the least you can do is bloody well check this simple thing, as it can ruin breastfeeding, and if there IS a tongue tie, offer the division! This should be a free service in all hospitals (as I was bloody lucky it was in mine).

DS1 had a partial posterior tongue tie, missed by 2 MWs and one doctor, but found by the breastfeeding expert who visited me when DS1 was about 36h old and still struggling massively to latch. She found it with her finger, taught me the best way to get him to latch and offered the referral straight away. Like an idiot (albeit a completely dazed sleep deprived one) I dithered about it, but luckily my home-visit MW was also a BF specialist, so she made the referral and I got DS1's tongue tie snipped when he was ~2w old. It made a huge difference, despite being only a relatively minor tongue tie.

DS2 also had a tongue tie but that took 5w to get snipped (bloody stupid system over here) and left him with some residual bad behaviours, which we're still having occasional trouble with a year later, having ruled out any other potential problems.

DH has a tongue tie and I know it runs in families, which is why I kept asking them to check.

Another vote for continuity of care - I saw 6 midwives during home visits the second time round and that was after being promised one-to-one care for a home birth (which never happened anyway).

I'd have loved my midwife to refrain from talk of induction and wanting to book me in for one when I was 39 weeks. My babies seem to come late but my due date was seen as a very rigid cut off. Despite regular contractions at 40 +15, I was hassled and talked down to and made to feel an induction the next day was the only option. I think it became a self fulfilling prophecy...

Post natal wards are horrible places. Exhausted, frightened and out of control is how I've felt on both occasions. Not enough staff (two midwives for 26 ante and post natal women and their babies in Derriford hospital!). No wonder the poor women were rushed off their feet, going without breaks and therefore not providing more than rudimentary care... Disgraceful and an accident waiting to happen. Not helpful and not the midwives' fault but very important nonetheless.

Oh yes, tongue tie checking and instant clipping please!

In any job you will get people who are good at it and those who aren't. Please please don't tar every midwife with the same brush and say we are all useless, incompetent or uncaring. It's not the case
^^^^^^

Just this :(

I would say that during labour is not the time to be discussing anything new. I agreed to an episiotomy during prem labour because I was in so much pain and out of my mind in terror that I had honestly lost my grip on reality - it had never been discussed, but for various reasons this is actually the last thing on the entire planet I'd be likely to agree to. Thankfully it didn't happen in the end, but there is no way I'd have been able to make an informed decision in that situation. Midwives should be discussing all possibilities fairly early on, and documenting a woman's feelings on various procedures in her notes.

Aidan and Tass having myself seen care ranging from the utterly brilliant to the downright dangerous, please fear not: I will be conveying that a lot of wonderful work is done by people who are kind, human and caring. I hardly think it'll be news to them that things go wrong: IMO the most important thing for me to convey is what can be done to make more of it go right.

I'm sure it's very upsetting to be a good midwife and hear some of these experiences, but I think it's extremely important to understand that this happens... Alot.

Also, it's not a 1:1 ratio of healing the damage done. Having 1 bad experience marks people deeply and the emotional effect should not be minimized. It leaves trauma and terror, long after the event itself. It doesn't make everything ok again if another nicer, kinder, competent midwife comes along (if one does).

That's what I mean by its not a 1:1 experience- one good experience does not wipe out the bad one. Why am I saying this?

1. Good midwives, please understand that you will have women come to you and have no trust in you at all due to bad experiences in the past.

Do not be defensive or get angry angry/ dismissive of this. Try and understand that although there are many good midwives, the woman in front of you may never have met one and has no reason to believe you. It's called learning from your experiences, and it would be stupid for a woman to keep trusting and being open to a profession that has let her down badly. Part of your job as a 'good' midwife is to deal with the consequences of not so good colleagues.

1. I think there is an expectation that women have to just get on with it

... or shut up about it, or that they are dwelling on it, or won't let go of it so are making it worse for themselves. Trauma gets worse when everyone else minimizes it. That means family & friends as well as midwives and wider medical profession

I would like to ask them to not assume I know what they mean 30 minutes after I have just pushed a 10lb baby out of my fanjo and passed out. I'm in shock, I don't know what's going on and have no idea what breast feedi is let alone where my breasts are. Telling me if I don't get in with it now I won't be alowed to is not helpful :( I needed a shoulder to cry on and someone to talk to me about what just happened to me. Dd was fine she was asleep she didn't need feeding that second. And wheeling my bed out of the delivery suite while my undressed baby is led on it and while dh was helping me to get dressed at 2am is also not helpful.
I ended up on the anti natal ward in shock with an undresse baby not able to get any clothes for her as I couldn't move with mw's who were so angry when I pressed Blythe button for help I daren't ask for any.

Wow sorry didn't quite mean to go there! Yea, well that was my expiearience and I don't think any woman should be treated like that :(

I may be being paranoid at this point but can I just re-state that I'm not/have never been/not planning to be a midwife (note to self be v careful with headings!). I'm a service user & have been asked for input. But I do agree reading this as a midwife would be very disheartening. TBH reading it as a patient is pretty upsetting too.

I also would add that dd1's care at a different hospital was second to none, brilliant, kind compassionate and amazing. I know there are brilliant mw's out there but there are some that just don't seem to have the compassionate gene

Cbeebies that sounds bloody horrific. I can't imagine anyone would disagree.

Lots of women hate being on their backs in labour. A good midwife can work around this, but most don't seem to expect to. Why is this?