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? :)

1. A little warmth goes a long way. Tough barky women scare me, even more so when I'm feeling vulnerable.

1. Stop mentioning my weight and your difficulty feeling the baby through my 'layers of adipose' or the risks associated with labour eg 'bleeding out'. I am not that enormous but have had my raised bmi mentioned at every appointment and three times given the very brutal leaflet entitled 'bmi and pregnancy'. Now is not really the time to go on a diet, I'm sorry I'm overweight but everytime you bring it up you make me feel like shit and more vulnerable. I'm 44 and you were far less worried about my age but, frig, did you yammer on about my weight.

1. Pain relief shouldn't be a bloody bargaining tool. When I beg for an epidural don't say 'ok ill get the anathesiologist' to come by, essentially lying to me. An hour later when I ask where he/she is and you say 'he's busy but will be here soon' then do a cheeky wink to my partner, do not think that is funny. You are lying to a patient! Be straight with me and just tell me that I'm too far along...!

When I say I want an epidural I mean it!

Please don't call me darling or poppet, if I have told you my name I would like you to use it.

I did not exchange my brain for the foetus inhabiting my uterus, I was a mentally competent adult before pregnancy and I remain so, something which a lot of midwives seem to forget!

I'm hoping to study and train as a midwife once I've had my kids and I'm all growed up so this thread is really useful :)

Point taken about you not being a midwife. What really annoyed me was the automatic use of my first name. The midwife, whom, I might meet once (and I met 37 hcps when I was pg with DS1) is not my friend, is not someone I know or would particularly like to know. The midwife is a professional adviser and I am her customer. The midwife is a complete stranger who might examine me vaginally and see me at my most vulnerable. In those circumstances I would like the midwife to ask me what I would like her to call me and to assume that unless I invite her to do so that I don't wish to be on first name terms. This particularly annoys me when midwives refer to the doctor as Dr or Mr Bloggs and uses my first name without asking. I do not know the midwife - the midwife knows them better than me. It is an equality issue and I don't like it assumed that I am subordinate to the doctor. I think it would also confer a little respect in relation to the patient.

I know hcps don't like this view but actually if I don't know them, and if they want to shove their arm up my fanny, at the very least I expect them to address me as Mrs Marrriedinwhite or at least ask me how I would like to be addressed. Isn't that just normal behaviour when dealing with someone you don't know who happens to be yours customer. Respect I think is the key and that is what is missing - anything to bring it to the forefront.

I didnt want the same Mw right through! She was awful, and known to be! ended up just seeing my gp instead.

• if you know the equipment might not work, tell me. Don't listen for the heartbeat, say " oh dear" when there isn't one, then turn away without saying anything to get a new listening thing.

• read the notes. You might discover I lost 2.5 litres of blood during my cs, so no, I am not " lazy lavender! Up you get for a shower! And I can't help you, I'm miss important with a meeting to get too"

That way, I might not have ended up collapsed on the floor bleeding and whimpering for help.

You might have have also realised sending the registrar who tried to try a new procedure out on me, and thankfully was reported instantly by the labour Mw and asked to leave by the consultant who she raced to get!!!

Sending him to tell me I needed a blood transfusion and he would be doing it wasnt a good idea. Shouting I was one of them Jehovah's when actually I just thought he was having another go at killing me, wasnt helpful.

Oh, and when you come in at night, and I can't get out of bed what with the epidural still wearing off, not speaking and removing my crying newborn and going off with him for 20 mins isn't a nice thing to do.

Also refusing to empty my bag ( full of wee, very painful) as its not your job, and I will have to wait for another shift- not good.

And then don't lecture my dh about being nice with me incase I get pnd.

And breathe...

I want to say Thank You to the lovely midwife who stayed beyond the end of her shift to 'finish the job' and see me give birth to DS2

Should you happen to see any of the fantastic team who delivered dd at Heartlands Birmingham please could you say thank you very much and give them a big hug?
Thanks

There were 4 nice Mw. 2 in the labour room and after my cs. I bled very badly after the cs, and they saved my life.

1 in the ward. Wonderful. Listened, took me away alone and apologised for the my treatment. Said this was why she only did cover work as being on a ward permanently with Mw like this is all too common.

The other was lovely too, sat down, listened to dh who was distressed enough with it all, asked if I wanted to have all visitors stopped! Including mil, I said hopefully, yes! She said. I wanted to hug her:)

Oh, and the dopey Mw, who told me my ds wasn't gaining weight so I couldn't leave- born at 5kg, bf, milk slower after cs. She showed me her working out of the expected weight gain and she had made a mistake! She had to get another Mw to show her how to use the calculator properly. I am an accountant and I know these things. She didnt apologise either!!

You have to question. Its ok, and the nice Mw are ok with that. The ones who role model prison guards don't.

Some of the stories on here are really sad.

I would like to say thank you to the Midwife who stayed on after her shift had finished to be there for my emcs, then stayed even later to hold my hand while I was put under general anaesthetic because the surgeon had done some pretty major damage. I will never forget her comforting presence at a time when I was terrified.

I was in hospital for over a week afterwards and during that time saw a lot of midwives. With just one exception, they were all incredible, many going well beyond the call of duty and bending many rules to keep me and my baby well, sane and happy. I am very surprised that my experiences are so different to other people's, especially since all the problems and trauma I suffered were at the hands of doctors. It was the midwives who were there to pick up the pieces.

The surgeon had a go as well. She managed to slit the skin round my unborn baby's eye during the cs, which was not an emergency cs. All quite calm til she went in with the knife.

He had stitches at birth. At least she said sorry.

All the midwives I saw were kind and professional.

I really really feel for midwives. They have to do an extremely physical tiring and emotionally draining job with minimal mediocre training and little or no professional autonomy or respect. There are so many complicated facets to their job that I think it's absolutely no wonder that many of them lose spirit and end up taking on a defensive mentality.

In how many jobs do you have to meet a person for the first time when they're scared and in pain, form a relationship withem while their partner is there and possibly also feeling scared or maybe even being a total dick, examine that person possibly vaginally then try to manage their pain and safety along witglh the safety of a tiny baby whom you can't see? It seems to me that the extent of expertise mws are expected to have does not tally at all with the professional respect/training they're given. They manage a complicated fraught and potentially fatal situation while dealing with collegues partner notes postnatal care procedures red tape etc etc possibly for more than one woman at a time. If it were men giving birth being w would be a well respected highly paid job with top notch training.

But it's "only" women "only" giving birth.

I do agree with what you say about the skill set and demands Cailin but so many HCP's including MW's think that paying no attention to their NMC Code Of Conduct is excused because they are stressed/underfunded/unappreciated.

There can be no excuse for much of what I have read here.

True mignonette and I certainly came across one mw who clearly didn't give a toss about me - she acted literally like I was an annoying bit of opinionated meat getting in the way of the baby. She completely and utterly ignored me - the other mw answered the questions I asked her with embarrassment. She did the "we're going to..." thing instead of asking consen and my worst memory of a very painful labour was being forced onto a bed and threatened (in the aggressive sense) with an episiotomy. I screamed "I do not consent to an episiotomy" and was again ignored until the other mw assured me they wouldn't do one. She was a horrible human being and if I saw her today it would take a lot of restraint for me not to spit in her face. Her nasty interference was totally unnecessary.

The two mws I had for my hb in contrast were angels.

Ushy thanks it means a lot that someone else thinks it wasn't an OK thing to do. Yes, I think listening is key.

Whistleforit Wanted to add that I have known several amazing midwives both personally and professionally. That as service user I am aware of the major pressures they face and I am really really happy to be involved in campaigning or what ever for maternity services so midwives are less streached so they can delivery the care women want and I think they want to provide. Women and midwives should be on the same side.

Women and midwives should be on the same side.

^^^^

Hazchem, Never a truer thing was said.

Hazchem totally agree that women and MWs should be on the same side. Ironically I got more kindness from the doctors than I did from the MWs - and many of the docs were male. Somehow I expected more from the MWs, being part of the 'sisterhood' and all...

whistle There are lots of things that could be done to improve services but in the end it all boils down to money. It's impossible to give excellent care if you don't even have the basic equipment you need. Each delivery room should have the basics, Doppler, CTG machine, blood pressure cuff, cosi cot etc. Instead of having the bare minimum on the floor and making midwives scrabble about to find equipment. There should be much better succession planning. Midwives are leaving the profession in droves due to retirement and working conditions, and those numbers aren't being replaced. More funds need to be directed to ensure more midwives are constantly being trained up..there's such a shortfall and there's really very little incentive to train for the job now. Which ultimately means that current midwives workloads are ridiculously high meaning we simply can't give the care needed. In my opinion one to one care in labor is a basic must have, but it's not the reality any more. As a midwife you are running from one room to the next praying that you manage to be in the right place at the right time when something goes wrong (when, not if!). There's also to much upskilling going on...people are being trained to do work that's outside of their actual sphere of practice. This is because it's cheaper to pay a BCA or an AIN to do the work of a midwife, and cheaper to pay a midwife to do a pediatricians job, so everyone is doing work that really should be done by the person above them on the pay scale. There's too much budget cuts and cost saving...the managers and the life who make these decisions NEED to work clinically at grass roots level to see the impossibility of the workloads they are expecting midwives to cope with along with the expectations of standards. They need to understand being grossly understaffed means mistakes WILL be made and that they need to be proactive about looking how to avoid those situations, rather than being reactive once something goes wrong. Maternity services IME trends to have a knee jerk reaction to events.
Having more funding and midwives also means that antenatal appointments will last longer than 10 minutes each. That's just not long enough to provide any support or education and no wonder women come out of appointments upset, confused and angry that they don't understand what's going on. Midwives have to keep to their visit schedule, if each appointment runs over (which it invariably does) it affects everyone else whos waiting. So women get upset when they don't have enough time with the midwife, but when she makes time then everyone else is upset and complains. Postnatal floors need to stop being the forgotten maternity service...There is NO way to effectively give everyone the attention they need and to help give support to women who need it. The begins the scenes paperwork etc that needs doing is overwhelming and detracts from patient care.I'm pretty sure diaries have shown that midwives spend more time completing paperwork than they do providing direct patient care. I reckon this is partly down to having to practice defensively and document everything in order to be covered` due to litigation concerns.
I'm sure there are other jobs that people work where they daily think...this could be the shift that ends in a court case,I could lose my job and my registration and it might not really even be my fault, but I was the one unlucky enough to be in that position, but that's how I felt going into work for EVERY shift.

Oh and some other thoughts:

when designing a maternity hospital SPEAK TO MIDWIVES who will be working there who will be able to provide you with lots of information about why something needs to be a certain way. Designers for example might see no problem in painting postnatal wards a lemon / yellow shade, but any midwife will tell you it's a daft idea. Same for ward layouts etc.

Work on a freaking solution to enable midwives to find the drug cupboard keys easily. The easiest thing IMO would be to create a button that you pos on the drug cupboard that sets a flashing, vibrating (but quiet) alarm on the set of keys that identifies to the holder they need go to the drug cupboard. Simple yeah? Just like those restaurants that have those things that beep and flash when your meals ready. Except there is nothing like that in any hospital I've worked at. I even bought key finders that I took into work which were advertised as having the range of a large football field. Except they didn't work because the sensor doesn't work around corners and through walks and doors. Honestly, if they could do ONE thing immediately to make things better it would be a bloody key finder system!!

I thought this thread was about what women ( service users ) want to say to midwives and not the other way around?

And I've not seen anyone on this thread ( unless I missed it) complaining about the colour of the wall on the ward

I HAVE seen a lot of posters complaining about not being listened to, rudeness and insensitivity and midwives banging on about their own agenda instead of being patient focussed.

Dropoyoursword -this really REALLY isn't the place for you to rant about the lack of job satisfaction for midwives. I'm not dismissing your concerns but this isn't the place for them IMO

Sorry Kristina, but OP asked me by name to mention processes that influenced care from a midwives point of view. Everything I mentioned was aimed at improving services for women, NOT for making midwives jobs easier. The keys for example, can take 20 minutes to find, which is 20 minutes too long in my opinion to leave someone in pain, who subsequently thinks she's been forgotten about or ignored. A midwives agenda is highly influenced by funding and policy which means that she is then accused of not caring/listening, when in fact she is actually powerless to do very much. I am not excusing a lot of the behaviors discussed here. Not gaining consent, being rude, telling people off etc are all absolutely inexcusable and if you saw my first post you'd see that I said that in my opinion the problems basically boil down to two issues, bad people and bad processes. Bad people need to be removed from post, and bad processes need to be changed.
I'm not sure why a midwives opinion here is classed as irrelevant...literally two posts before mine stated women and midwives need to work together. And I have also quit working as a midwife in the UK as it is too stressful. But as a woman I can also be a service user. If I can see what issues exist why shouldn't I point them out.

(The color of the walls, by the way, I mentioned because as a midwife I would say don't do that because it causes a yellow tinge to skin color and therefore affects the ability to assess neonatal jaundice. It was a comment simply to highlight that people who create maternity wards or write policy aren't always privy to hints, tips and information that could otherwise improve everyone's experience)

I'm sorry if I misunderstood your motives Dropthdsword.

Dropyoursword your points are very valid and an important part of the debate.

What is interesting is that you are not being listened to either - I agree if you had more say in what goes on you could devise better services.

Some of the things you mention, like spending 20 minutes to find keys, is not to do with lack of funding, it is to do with management.

Excessive paperwork could be addressed - I agree there is far too much but again, that does not need more money.

There should also be recognition of how much is being frittered away in litigation arising from poor care.

I just don't think more money is going to come in the current economic climate but a lot of what you suggest could be achieved by reducing waste - including unnecessary litigation - and better management which includes giving ordinary midwives more engagement in running services.